More and more people are using telehealth. Now the system itself needs an exam.

April 16, 2019
Meeting Street Academy student is:.Addison Ancrum Christian Miley, MUSC Center for Telehealth School-Based Health Assistant (the person in with the children at the school) Kelli Garber MSN, APRN, PPCNP-BC.Lead Advanced Practice Provider and Clinical Integration Specialist.The Center for Telehealth.(On the Telehealth cart screen)
Meeting Street Academy student Addison Ancrum gets a telehealth exam. Photo by Sarah Pack

A study that found some commercial telehealth doctors are prescribing antibiotics to kids who don’t need them is actually encouraging in a strange way, says MUSC Children’s Health pediatrician David McSwain, who is also the chief medical information officer for the Medical University of South Carolina. It shows telehealth, also known as telemedicine, is getting the research scrutiny it needs.

And thanks to a $3.6 million grant that the National Institutes of Health just awarded to MUSC, that scrutiny is about to intensify.

“We are leading a national collaborative looking into pediatric telehealth practices,” McSwain says. It’s called SPROUT, which stands for Supporting Pediatric Research on Outcomes and Utilization of Telehealth.

The antibiotic study was not part of SPROUT, but it’s a perfect illustration of why the network is so important. While the American Academy of Pediatrics discourages families from using direct-to-consumer telehealth outside of a child’s usual primary care office for kids who have viruses or bacterial infections, some use it for that purpose anyway.

When they do, the AAP study found they’re more likely to get antibiotics than they would if they did an in-person visit, even when they don’t really need them. The downside is that kids are taking medication that doesn’t help and they’re increasing their bodies’ resistance to antibiotics in the future.

Telehealth is already closely monitored at MUSC Health, which is part of the Medical University of South Carolina. Emergency medicine doctor Edward O’Bryan sees patients through the online system MUSC Health Virtual Care.

He said he follows the same Infectious Diseases Society of America antibiotic prescribing guidelines for online patients as he does for in-person appointments. “We have not done a head-to-head comparison, but our antibiotic prescribing for kids with respiratory infections is a good bit lower than noted in the article.”

The American Academy of Pediatrics study found 52% of children got an antibiotic from a telehealth visit compared to 42% at an urgent care clinic and 31% from a primary care doctor.

The study stands out not only for its findings but also because it offers hard data about telehealth on a fairly large scale. It’s exactly the kind of research McSwain wants to see a lot more of through the SPROUT grant.

“Research into the real impact of telehealth services is a critical part of developing and growing programs with the greatest potential to improve our health care system,” he says. “Many doctors and other health care providers are hesitant about incorporating telehealth into their practices because it’s difficult to separate the theoretical benefits from the real value.”

MUSC Health has incorporated telehealth into multiple areas. Its stroke specialists use the technology to help doctors in rural South Carolina during the “golden hour” that gives stroke patients the best shot at recovery. Psychiatrists use telehealth to take care of patients who can’t easily get to MUSC Health. Some school nurses use it to get quick care for kids. Overweight people who live two hours from Charleston can have online video appointments with MUSC Health nutritionists without leaving their hometowns.

McSwain and his colleagues will use the $3.6 million SPROUT grant to:

  • Support telehealth research.
  • Come up with metrics, or ways to measure and compare telehealth programs.
  • Figure out what the best practices are.
  • Develop policy and advocacy materials.

Other institutions involved in using the grant include the University of Colorado-Children’s Hospital Colorado, the Children’s Hospital of Philadelphia and Mercy Clinic in St. Louis.

McSwain said they already know one thing: “Telehealth that is practiced within the context of the patient’s medical home has huge potential to improve their care and result in improved coordination and quality of care.”


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