by Judy Mottl


Telemedicine, no doubt, is helping to save lives. In some instances, it’s being used to stem widespread illness in emerging countries. It also can save money for providers and payers, hence, also for consumers. What’s more, the practice continues to gain traction as an alternative to in-person visits.

Still, it’s not anywhere near perfect; big challenges lie ahead

Case in point, the findings of a new Rand Corp. study, published in JAMA Internal Medicine, on telemedicine prescription behaviors. The research reveals prescription decisions are different in a telemedicine environment than in a traditional office visit. Simply, telemedicine providers in the study prescribed a heck of a lot more broad-spectrum antibiotic than traditional physician offices–86 percent to 56 percent.

This is concerning for a few reasons:

  • Overuse leads to more costs and contributes to antibiotic resistance
  • It may illustrate that telemedicine providers take a conservative approach with antibiotics, going broad to ensure treatment impact
  • It may indicate a broad remedy is scripted as the telemedicine environment doesn’t provide enough diagnostic information and insight compared to an office visit

All these issues require further study, lead author Lori Uscher-Pines, a RAND policy researcher, told me in an email.

“We should be wary of any general statements about quality that apply to an entire industry,” she said regarding the study’s findings. Research like this, she said, is only a first step to making accurate determinations about prescription behaviors.

I wholeheartedly agree. Uscher-Pines continued.

“Telehealth can be a great tool to increase access if it is deployed appropriately,” she said. “More research is needed to determine the kinds of services and the populations of patients that can use this tool safety and cost-effectively.”

Hopefully as more research is initiated, inroads can be made to ensure current prescription activity remains valuable and on target. Uscher-Pines said telemedicine providers can educate patients on drugs such as antibiotics, and ensure patients understand use of antibiotics for specific needs.

She also advised telemedicine providers to begin auditing visits and assess clinical practice guidelines to ensure the same standards applied in the office environment are followed in a remote environment.

Is this a bump in the road for telemedicine? Definitely. But virtual visits are only going to become more ubiquitous, particularly with new reimbursement models dictating quality over quantity.

This is less about pointing a disapproving finger at the method, and more about simply getting it right.

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