Antibiotic Prescribing for Acute Rhinosinusitis: In‐Person Versus Virtual Visits During Covid‐19

Abstract

Objectives/Hypothesis: Determine if antibiotic prescribing patterns differ for in-person versus virtual clinic visits for acute rhinosinusitis (ARS).Study Design: Cross sectional study. Methods: All adult virtual clinical encounters from March to May 2020 with a principal diagnosis of ARS were reviewed for demographic data and the presence or absence of an antibiotic prescription during the coronavirus shut down in Massachusetts. In-person clinical encounters from March to May 2019 were similarly examined as a control. The rate of antibiotic prescription was compared between virtual (2020) and in-person ( 2019) visits for ARS diagnoses.Results: There were 2,075 patients in March to May 2020 and 3,654 patients March to May 2019 who received an ARS principal diagnosis at their virtual and in-person outpatient visits, respectively. There was a statistically significant lower rate of antibiotic prescriptions for ARS in 2020 (72.1%) versus 2019 (76.7%).The odds ratio for an antibiotic prescription for ARS was 0.783 (95% confidence interval, 0.693-0.86; P < .001) for patients seen in the 2020 cohort versus the 2019 cohort. The compared rates for antibiotic prescribing for 2020 versus 2019 were not different in individual month-to-month comparisons. When stratified by otolaryngology providers there was no statistically significant difference of antibiotic prescriptions between the 2019 and 2020 cohort (P = .781).Conclusions: During the massive transition to virtual visits for March to May 2020 due to the coronavirus pandemic shut down in Massachusetts, the total rate of outpatient antibiotic prescribing for ARS was lower in the virtual visit environment compared to the traditional in-person visit. In this scenario, telemedicine did not result in an increase in antibiotic prescribing despite the lack of an in-person physical exam.

Outpatient antibiotic prescribing for common infections via telemedicine versus face-to-face visits: Systematic literature review and meta-analysis

“…1). Of these 23 studies, 19 were retrospective cohort studies, 7,8,12,14-29 2 were cross-sectional studies, 30,31 1 was a case-control study, 32 and 1 was a randomized controlled trial 33 (Table 1). Of the 22 observational studies, 7 studies used matching between the exposed group (telemedicine) and the nonexposed group (faceto-face visits).…”

“…8,25,28 For telemedicine modalities, 17 studies evaluated synchronous video and/or phone visits, 8,12,[15][16][17][20][21][22][23][24][25][26][27][28][29]31,33 7 evaluated asynchronous text or internet visits, 7,14,18,[26][27][28][29] and 3 neither specified nor separated those 2 modalities. 19,30,32 Also, 16 studies evaluated clinic visits, 7,8,14,18-22,24,26-33 9 evaluated urgent care, 8,12,15,16,21,23,25,30,31 5 evaluated emergency departments, 17,19,23,30,31 and 4 evaluated retail clinic visits. [26][27][28]30 The most commonly evaluated indication was sinusitis, which was reported in 10 studies,…”

“…19,30,32 Also, 16 studies evaluated clinic visits, 7,8,14,18-22,24,26-33 9 evaluated urgent care, 8,12,15,16,21,23,25,30,31 5 evaluated emergency departments, 17,19,23,30,31 and 4 evaluated retail clinic visits. [26][27][28]30 The most commonly evaluated indication was sinusitis, which was reported in 10 studies, 7,8,15,18,[21][22][23]27,30,32 followed by upper respiratory infection (URI), which was reported in 6 studies, 8,12,16,21,22,30 urinary tract infection (UTI), which was reported in 5 studies, 7,14,19,26,30 pharyngitis, which was reported in 5 studies, 8,16,21,22,30 and otitis media, which was reported in 4 studies. 8,…”

“…The association between antibiotic prescribing and telemedicine compared to face-to-face visits varied among studies. Also, 5 studies 15,18,21,27,32 reported more antibiotic prescribing in face-to-face visits; 2 studies 7,30 reported more antibiotic prescribing in telemedicine; and 3 studies 8,22,23 did not find a statistically significant difference. Those 10 studies were highly heterogenous (Supplementary Fig.…”

“…Ten observational studies compared antibiotic prescribing for patients with sinusitis via telemedicine and face-to-face visits. 7,8,15,18,[21][22][23]27,30,32 In total, 21,640 patients (range, 57-16,168) with sinusitis were treated via telemedicine visits and 588,749 patients (range, 100-469,828) were treated via face-to-face visits. Antibiotics were prescribed for 64.8% of telemedicine and 65.9% of face-to-face visits, respectively.…”