Does Telemedicine Encourage Overprescribing—or Provide Crucial Access Where It’s Lacking?

Telemedicine is a hot topic in urgent care circles these days. Some industry leaders herald it as a new way to reach patients and to extend an operation’s reach; skeptics express concern that it’s an obstacle to building a healthy provider–patient relationship and that it facilitates overprescribing. While some of this boils down to a difference of opinion, evidence is mounting that both arguments have merit. A new study out of the University of Pittsburgh School of Medicine suggests that physicians really may be more inclined to prescribe unwarranted antibiotics to children during telemedicine visits. The children studied received an antibiotic prescription more often during a telemedicine visit than during an in-person visit (52% vs 31%). Clinical guidelines were less likely to be followed, too (only 59% of the time during a telemedicine encounter vs 78% in an office visit). On the other hand, the medical director of telehealth at the University of Alabama-Birmingham hospital insists telehealth is already saving lives in his state. Eric Wallace, MD was quoted in a story that ran on local news CBS42 saying that stroke victims in rural Alabama often face a 90-minute drive to the nearest facility with a neurologist on duty. Thanks to 55 telehealth carts that have been placed in strategically selected facilities by the Alabama Department of Public Health, however, the average time to be “seen” by a neurologist is down to 5 minutes—a difference that has literally meant life vs death for some patients. The current issue of JUCM offers a deep discussion of the pros and cons of telehealth in the urgent care setting, featuring the perspectives of Stanford Coleman, MD, MBA, FAAP, vice president and chief networking officer for medical affairs and community relations for Righttime Medical Care in Maryland (and a strong telemedicine proponent) and William Gluckman, DO, MBA, FACEP, president and CEO of FastER Urgent Care in Morris Plains, NJ as well as a clinical assistant professor of emergency medicine at Rutgers New Jersey Medical School (and currently a telehealth skeptic).