The Ray et al study1  of DTC company antibiotic prescribing compared with urgent care and pediatricians’ offices for ARI brought up a legitimate concern about overprescribing antibiotics over telehealth. There were several limitations to this study, eloquently outlined by Jeffrey S. Gerber,2  which included looking at filled prescriptions, data from only 1 company, unknown sociodemographic factors, and total telehealth visits being a small percentage of overall visits. Regardless, the authors and the commentator are absolutely right; concern about antibiotic prescribing is legitimate. As we deal with the ever-growing threat of antibiotic resistant strains of bacteria, we, as physicians, have had to backtrack and undo the damage created by overprescribing antibiotics, both scientifically as well as culturally.

The study does, however, bring into question the use of DTC telehealth by parents, which is differentiated by pediatrician office run telehealth offered to existing patients. The American Academy of Pediatrics (AAP) has discouraged use of these types of private companies for pediatrics and the ATA also has concern of using them for children under 2 years of age. The concerns are that current telehealth practice patterns almost never warrant antibiotic prescription for ARI due to lack of ear exam, radiograph, or strep test. Some DTC companies don’t have pediatrician staffing, and patients are lost to follow-up which is detrimental to long-term care.

Some of these concerns have easier solutions than others as telehealth has grown considerably over the last 5 years; there are more physicians working in the space allowing for the right physician seeing the right age group. There’s a recognition that staffing should be similar to other physician practices that include quality assurance, antibiotic stewardship, compliance, and recredentialing. All of that can improve antibiotic prescribing patterns.

However, dictating that parents should be discouraged from using DTC is unrealistic. Most of those who have used the service are likely to use it again. Also, it might be an issue of access, which is not limited to having insurance but includes transportation, parents’ ability to take time off work, amount of copay, and access to a clinic. Under these circumstances, the alternative to a telehealth visit may be no medical encounter and no care. Ideally all patients could see their own doctor but that is not always feasible based on financial and social constraints. DTC, however, does need to create steps for better quality care for pediatrics until all patients can get the care they need when they need it.

Local telehealth options by pediatricians are going to be the adjunct to primary care in the future. In the meantime, other means of care provided by DTC companies are rapidly spreading and filling gaps. Simply asking parents not to use it won’t be a long-term solution to a very real concern about the quality of virtual health care. We have a real responsibility to work within the confines of our current climate which currently includes telehealth and is unlikely to trek backward.

1.
Ray
KN
,
Shi
Z
,
Gidengil
CA
,
Poon
SJ
,
Uscher-Pines
L
,
Mehrotra
A
.
Antibiotic prescribing during pediatric direct-to-consumer telemedicine visits
.
Pediatrics
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2019
;
143
(
5
):
e20182491
2.
Gerber
JS
.
Need an antibiotic? There’s an app for that
.
Pediatrics
.
2019
;
143
(
5
):
e20190631

Competing Interests

CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.