Antibiotic Stewardship in Outpatient Telemedicine: Adapting Centers for Disease Control and Prevention Core Elements to Optimize Antibiotic Use

Sanchez, Guillermo V.; Kabbani, Sarah; Tsay, Sharon V.; Bizune, Destani; Hersh, Adam L.; Luciano, Angelina; Hicks, Lauri A.

doi:10.1089/tmj.2023.0229

Cited by 5 publications

(4 citation statements)

References 68 publications

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“…While some of these factors, if found to be contributing, may require solutions specific to telemedicine (eg, developing protocols to smoothly transition to local in-person care), other factors may benefit from outpatient antibiotic stewardship methods. Effective interventions to improve existing ARTI quality metrics exist for in-person outpatient settings, and important work is adapting these interventions for telemedicine settings . Our results also highlight the need to use antibiotic quality metrics that are diagnosis-specific (which may mask increased antibiotic use due to overdiagnosis) alongside broader measures to monitor and guide improvement in antibiotic management.…”

Section: Discussionmentioning

confidence: 86%

“…Effective interventions to improve existing ARTI quality metrics exist for in-person outpatient settings, and important work is adapting these interventions for telemedicine settings. 14,[34][35][36][37][38] Our results also highlight the need to use antibiotic quality metrics that are diagnosis-specific 39,40 (which may mask increased antibiotic use due to overdiagnosis) alongside broader measures 41,42 to monitor and guide improvement in antibiotic management.…”

Section: Jama Network Open | Pediatricsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 86%

Section: Jama Network Open | Pediatricsmentioning

confidence: 99%

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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“…Screening and prioritizing are the two crucial terms in this study. Though telecommunications-telecare, and remote surveillance were taken into consideration, the subject matter was restricted to literary works in English (Sanchez et al 2023). The three online databases that were utilized to look for the desired articles were:…”

Section: Methodical Procedures For Reviewing Prioritizing and Screeni...mentioning

confidence: 99%

Examining medical urgent and patient precedence within the telemedicine landscape with its infrastructure and policies: A comprehensive review

Patel,

Sharma,

Gupta

et al. 2024

Multidiscip. Rev.

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Medical facilities are confronted with grave issues, including a population that is aging and a physician shortage. In an effort to address these issues, telehealth and remote health monitoring systems (RHMS) aim to reduce hospital visits by a small amount. RHMS lessens the workload for primary care patients and enhances inter-unit communication, which lessens the strain on emergency rooms. Due to significant advancements in mobile information transfer and processing of signal technologies, some healthcare researchers have made efforts to employ RHMS in place of hospital visits to provide triage and prioritization for individuals. Prioritization is a strategy for giving people urgent medical care in an attempt to save their lives, while clinical examination determines the severity of a sickness or damage. To emphasize the disadvantages of the present patient screening and prioritization system over the telehealth environment, a crucial inquiry is needed. Based on two crucial axes, an in-depth examination of patient prioritization and medical crisis assessment in a videoconferencing setting was provided in this research. First, a collection, analysis, and classification of earlier research on triage of patients and prioritization in this kind of setting was done. Second, a variety of priorities and standards, as well as various approaches and procedures for prioritization, were provided and examined. The subsequent outcomes were attained: The shortcomings and issues with the current patient prioritization and assessment methods were highlighted. The assessment and priority for individuals who have cardiac conditions were not presented. In the years to come, a structure based on the theory of evidence, as well as the incorporation of a multiple-layer analytical hierarchy approach and method for ranking preference due to resemblance to perfect solutions, can be used to prioritize the care of several patients with ongoing cardiovascular disease by triaging them based on various emergencies dimensions.

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“…Telemedicine facilitates patient access to health care services throughout the entire health care process through means such as prevention [4], diagnosis [5], treatment [6],…”

Section: Introductionmentioning

confidence: 99%

Assessing the Impact of Telemedicine Interventions on Health Care Costs and Utilization: A Scoping Review (Preprint)

Liu,

Kumluang,

Gaewkhiew

et al. 2024

Preprint

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BACKGROUND The utilization of telemedicine has increased notably since the onset of the pandemic. Understanding the influence of telemedicine on health care costs and utilization can contribute to the monitoring and evaluation of telemedicine programs. OBJECTIVE This scoping review aimed to document the potential impact of telemedicine on health care costs and utilization across diverse health care contexts and to offer a summary of the statistical methodological approaches employed in assessing the impact of telemedicine on health care costs and utilization. METHODS A literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews guidelines, spanning the last 10 years across 3 electronic databases: PubMed/Medline, Web of Science, and Scopus. The search strategy was in accordance with the PICO criteria; patients were defined as the target population; telehealth or telemedicine was defined as the intervention; and standard care or before-and-after self-comparison was defined as the comparison, with health care costs and utilization as the outcome measures. Additionally, the six different structural layers of the TOAST framework for telehealth services were utilized to characterize the interventions. The findings were synthesized and are presented in tables and figures for clarity. RESULTS Out of a total of 4,454 identified articles, 14 were selected for review, with approximately 36% (n=5) focusing on chronic conditions. The delivery modalities included telephone call, videoconference, web portal, and smartphone applications, mainly spanning teleconsultation, telemonitoring, and teletherapy with clinicians and nursing support or health care team involvement. Approximately 86% of the studies employed standard face-to-face clinical visits for the control group. Six out of the 12 studies evaluating health care costs and four out of the seven studies assessing health care utilization revealed statistically significant improvements in telehealth compared to the control group. In addition, approximately 43% of the studies conducted univariate and multivariable analyses, with half of the studies incorporating adjusted analyses to control for confounding variables. CONCLUSIONS Our scoping review suggested that, in the treatment phase, compared with standard face-to-face clinical visits, telemedicine has the potential to decrease health care costs and optimally utilize health resources. Additionally, a regression model was the most commonly used statistical approach for assessing the impact of telemedicine.

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Antibiotic Stewardship in Outpatient Telemedicine: Adapting Centers for Disease Control and Prevention Core Elements to Optimize Antibiotic Use

Cited by 5 publications

References 68 publications

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

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

Examining medical urgent and patient precedence within the telemedicine landscape with its infrastructure and policies: A comprehensive review

Assessing the Impact of Telemedicine Interventions on Health Care Costs and Utilization: A Scoping Review (Preprint)

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