Haddad Raymond N, Sakr Celine, Khabbaz Lydia, Azouri Hayat, Eid Bassam
Department of Pediatrics, Hotel Dieu de France University Medical Center, Saint Joseph University, Beirut, Lebanon.
Faculty of Pharmacy, Saint-Joseph University, Medical Sciences Campus, Beirut, Lebanon.
Front Pediatr. 2020 Jan 15;7:515. doi: 10.3389/fped.2019.00515. eCollection 2019.
To evaluate phone-based consultation practices and drug prescription profiles in pediatrics and to highlight their possible uses, contributing factors, and effects on clinical outcomes. The ownership and everyday use of cell phones are increasing worldwide. Telehealth is gaining the support of health professionals for the delivery of simple healthcare measures to more complex management decisions. Despite this, in our country, doctors have been advised by concerned authorities to avoid any phone-based medical activity as the safety of such practices is still not well-established, especially among vulnerable pediatric patients. This cross-sectional study was conducted on a national level over 5 months. Phone consultations and prescription behaviors data were collected through a self-administrated questionnaire. The target population consisted of pediatric-trained physicians with at least 1 year of experience. Factors influencing telephone prescriptions were assessed using bivariate analysis. Of among 120 included physicians (75.0% male), 64.2% were general pediatricians, 77.5% practiced in private clinics, and 27.5% had more than 20 years of work experience. All participants gave medical advice over the phone; 61.7% considered that they should be reimbursed for these activities and 29.2% of them reviewed 50% of their patients for the same complaint. A total of 109 participants (90.8%) prescribed drugs using a direct phone call (80.7%), SMS (27.5%), or WhatsApp application (61.5%). Antipyretics (97.2%) and cough suppressants (48.1%) were the most frequently prescribed drugs. Pharmacists' corrective interventions were seen in 40.4% of prescriptions. Fever was the only symptom that was statistically associated with phone prescriptions. Prescribers seemed to be less experienced and were more likely to consider phone-based practices as reimbursable activities. Consultations and prescriptions through mobile phones are extremely frequent in pediatric practices, even when restricted by responsible authorities. Our results highlight the frequency of medical prescription errors and the need for corrective interventions by pharmacists. The current practice of telemedicine may not ensure the patient's safety but exists rather as a convenience. There is a need for proper oversight with a regulatory framework and input from all stakeholders, including pediatricians and pharmacists.
评估儿科基于电话的咨询实践和药物处方情况，并突出其可能的用途、影响因素以及对临床结果的作用。手机的拥有量和日常使用率在全球范围内都在增加。远程医疗在提供简单医疗措施到更复杂的管理决策方面正获得卫生专业人员的支持。尽管如此，在我国，有关当局已建议医生避免任何基于电话的医疗活动，因为此类做法的安全性仍未得到充分确立，尤其是在易受伤害的儿科患者中。这项横断面研究在全国范围内进行了5个月。通过自填问卷收集电话咨询和处方行为数据。目标人群为至少有1年经验的儿科培训医生。使用双变量分析评估影响电话处方的因素。在纳入的120名医生中（75.0%为男性），64.2%是普通儿科医生，77.5%在私人诊所执业，27.5%有超过20年的工作经验。所有参与者都通过电话提供医疗建议；61.7%认为他们应该因这些活动获得报销，其中29.2%的人针对相同的投诉对50%的患者进行了复查。共有109名参与者（90.8%）通过直接电话（80.7%）、短信（27.5%）或WhatsApp应用程序（61.5%）开药。退烧药（97.2%）和止咳药（48.1%）是最常开具的药物。40.4%的处方有药剂师的纠正干预。发烧是唯一与电话处方有统计学关联的症状。开处方者似乎经验较少，并且更有可能将基于电话的做法视为可报销的活动。即使受到有关当局的限制，儿科实践中通过手机进行的咨询和处方也极为频繁。我们的结果突出了医疗处方错误的频率以及药剂师进行纠正干预的必要性。当前的远程医疗实践可能无法确保患者安全，而更多是出于便利。需要有适当的监督以及监管框架，并需要包括儿科医生和药剂师在内的所有利益相关者的投入。
