Antibiotic Prescribing Practices: Is There a Difference Between Patients Seen by Telemedicine Versus Those Seen In-Person?

Yao, Peter; Clark, Sunday; Gogia, Kriti; Hafeez, Baria; Hsu, Hanson; Greenwald, Peter

doi:10.1089/tmj.2018.0250

Cited by 18 publications

(31 citation statements)

References 8 publications

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“…Difficult access to medical visits (including both in-person and virtual case visits) could potentially be another reason for the reduced antibiotic prescriptions [ 22 ]. Virtual care may present diagnostic challenges; however, several studies have identified similar or reduced antibiotic prescribing practices compared with in-person care [ 9 , 23–25 ]. However, our study could not evaluate the direct causality between the increasing trend of virtual visits and the reduction of antibiotic prescriptions.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis

Kitano

Brown

Daneman

et al. 2021

Open Forum Infectious Diseases

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Background The coronavirus disease 2019 (COVID-19) pandemic has potentially impacted outpatient antibiotic prescribing. Investigating this impact may identify stewardship opportunities in the ongoing COVID-19 period and beyond. Methods We conducted an interrupted time series analysis on outpatient antibiotic prescriptions and antibiotic prescriptions/patient visits in Ontario, Canada, between January 2017 and December 2020 to evaluate the impact of the COVID-19 pandemic on population-level antibiotic prescribing by prescriber specialty, patient demographics, and conditions. Results In the evaluated COVID-19 period (March–December 2020), there was a 31.2% (95% CI, 27.0% to 35.1%) relative reduction in total antibiotic prescriptions. Total outpatient antibiotic prescriptions decreased during the COVID-19 period by 37.1% (95% CI, 32.5% to 41.3%) among family physicians, 30.7% (95% CI, 25.8% to 35.2%) among subspecialist physicians, 12.1% (95% CI, 4.4% to 19.2%) among dentists, and 25.7% (95% CI, 21.4% to 29.8%) among other prescribers. Antibiotics indicated for respiratory infections decreased by 43.7% (95% CI, 38.4% to 48.6%). Total patient visits and visits for respiratory infections decreased by 10.7% (95% CI, 5.4% to 15.6%) and 49.9% (95% CI, 43.1% to 55.9%). Total antibiotic prescriptions/1000 visits decreased by 27.5% (95% CI, 21.5% to 33.0%), while antibiotics indicated for respiratory infections/1000 visits with respiratory infections only decreased by 6.8% (95% CI, 2.7% to 10.8%). Conclusions The reduction in outpatient antibiotic prescribing during the COVID-19 pandemic was driven by less antibiotic prescribing for respiratory indications and largely explained by decreased visits for respiratory infections.

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Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis

Kitano

Brown

Daneman

et al. 2021

Open Forum Infectious Diseases

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“…Of the 22 observational studies, 7 studies used matching between the exposed group (telemedicine) and the nonexposed group (faceto-face visits). 8,17,[21][22][23]30,31 Of 23 studies, 21 were conducted in the United States, 7,8,12,14-23,25-32 1 was conducted in Denmark, 24 and 1 was conducted in the United Kingdom. 33 Of the 21 studies conducted in the United States, 4 studies used a claim-based database 8,21,22,30 and the others were conducted either in a single healthcare system or in a primary care network.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 23 studies, 11 included only adults, 12,14-18,21,22,26,27,32 7 investigated both adults and children, 19,20,23,24,30,31,33 and 3 involved only children. 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,…”

Section: Resultsmentioning

confidence: 99%

“…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,…”

Section: Resultsmentioning

confidence: 99%

“…8,16,21,22 Finally, 15 studies earned 18 points or more in the Downs and Black scale and therefore were considered high-quality studies (Supplementary Table 2 online). 8,12,14,[17][18][19][20][21]23,[26][27][28]30,31,33…”

Section: Resultsmentioning

confidence: 99%

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

Suzuki

Marra

Hasegawa

et al. 2021

ASHE

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Objective: To evaluate the frequency of antibiotic prescribing for common infections via telemedicine compared to face-to-face visits. Design: Systematic literature review and meta-analysis. Methods: We searched PubMed, CINAHL, Embase (Elsevier platform) and Cochrane CENTRAL to identify studies comparing frequency of antibiotic prescribing via telemedicine and face-to-face visits without restrictions by publish dates or language used. We conducted meta-analyses of 5 infections: sinusitis, pharyngitis, otitis media, upper respiratory infection (URI) and urinary tract infection (UTI). Random-effect models were used to obtain pooled odds ratios (ORs). Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic test. Results: Among 3,106 studies screened, 23 studies (1 randomized control study, 22 observational studies) were included in the systematic literature review. Most of the studies (21 of 23) were conducted in the United States. Studies were substantially heterogenous, but stratified analyses revealed that providers prescribed antibiotics more frequently via telemedicine for otitis media (pooled odds ratio [OR], 1.26; 95% confidence interval [CI], 1.04–1.52; I2 = 31%) and pharyngitis (pooled OR, 1.16; 95% CI, 1.01–1.33; I2 = 0%). We detected no significant difference in the frequencies of antibiotic prescribing for sinusitis (pooled OR, 0.86; 95% CI, 0.70–1.06; I2 = 91%), URI (pooled OR, 1.18; 95% CI, 0.59–2.39; I2 = 100%), or UTI (pooled OR, 2.57; 95% CI, 0.88–7.46; I2 = 91%). Conclusions: Telemedicine visits for otitis media and pharyngitis were associated with higher rates of antibiotic prescribing. The interpretation of these findings requires caution due to substantial heterogeneity among available studies. Large-scale, well-designed studies with comprehensive assessment of antibiotic prescribing for common outpatient infections comparing telemedicine and face-to-face visits are needed to validate our findings.

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Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors

Wittman,

Hoberman,

Mehrotra

et al. 2024

JAMA Netw Open

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ImportancePrior research found that pediatric direct-to-consumer (DTC) telemedicine visits are associated with more antibiotic prescribing than in-person primary care visits. It is unclear whether this difference is associated with modality of care (telemedicine vs in-person) or with the context of telemedicine care (primary care vs not primary care).ObjectiveTo compare antibiotic management during telemedicine visits with primary care practitioners (PCPs) vs commercial direct-to-consumer (DTC) telemedicine companies for pediatric acute respiratory tract infections (ARTIs).Design, Setting, and ParticipantsThis retrospective, cross-sectional study of visits for ARTIs by commercially insured children 17 years of age or younger analyzed deidentified medical and pharmacy claims in OptumLabs Data Warehouse data, a national sample of commercial enrollees, between January 1 and December 31, 2022.ExposureSetting of telemedicine visit as PCP vs DTC.Main Outcomes and MeasuresThe primary outcome was percentage of visits with antibiotic receipt. Secondary outcomes were the percentages of visits with diagnoses for which prescription of an antibiotic was potentially appropriate, guideline-concordant antibiotic management, and follow-up ARTI visits within the ensuing 1 to 2 days and 3 to 14 days. The ARTI telemedicine visits with PCP vs DTC telemedicine companies were matched on child demographic characteristics. Generalized estimated equation log-binomial regression models were used to compute marginal outcomes.ResultsIn total, data from 27 686 children (mean [SD] age, 8.9 [5.0] years; 13 893 [50.2%] male) were included in this study. There were 14 202 PCP telemedicine index visits matched to 14 627 DTC telemedicine index visits. The percentage of visits involving receipt of an antibiotic was lower for PCP (28.9% [95% CI, 28.1%-29.7%]) than for DTC (37.2% [95% CI, 36.0%-38.5%]) telemedicine visits. Additionally, fewer PCP telemedicine visits involved receipt of a diagnosis in which the use of antibiotics may be appropriate (19.0% [95% CI, 18.4%-19.7%] vs 28.4% [95% CI, 27.3%-29.6%]), but no differences were observed in receipt of nonguideline-concordant antibiotic management based on a given diagnosis between PCP (20.2% [95% CI, 19.5%-20.9%]) and DTC (20.1% [95% CI, 19.1%-21.0%]) telemedicine visits. Fewer PCP telemedicine visits involved a follow-up visit within the ensuing 1 to 2 days (5.0% [95% CI, 4.7%-5.4%] vs 8.0% [95% CI, 7.3%-8.7%]) and 3 to 14 days (8.2% [95% CI, 7.8%-8.7%] vs 9.6% [95% CI, 8.8%-10.3%]).Conclusions and RelevanceCompared with virtual-only DTC telemedicine companies, telemedicine integrated within primary care was associated with lower rates of antibiotic receipt and follow-up care. Supporting use of telemedicine integrated within pediatric primary care may be one strategy to reduce antibiotic receipt through telemedicine visits.

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Antibiotic Prescribing Practices: Is There a Difference Between Patients Seen by Telemedicine Versus Those Seen In-Person?

Cited by 18 publications

References 8 publications

The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis

The Impact of COVID-19 on Outpatient Antibiotic Prescriptions in Ontario, Canada; An Interrupted Time Series Analysis

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

Antibiotic Receipt for Pediatric Telemedicine Visits With Primary Care vs Direct-to-Consumer Vendors

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