Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review

Abstract

Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.

Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018–2021

“…However, to our knowledge, there is still limited attention given to addressing antibiotic prescribing in teleconsultation. 24 There are several tools and strategies that could be explored to improve antibiotic prescribing in teleconsultation. For example, integrating artificial intelligence-enabled algorithms, such as automatic alerts within patients’ EHR could assist in promoting appropriate prescribing decisions.…”

“…For each teleconsultation, we extracted the season, distinguishing between summer (April–September) and winter (October–March). 24 We also coded whether the teleconsultation was performed by a practitioner having ‘extensive experience in teleconsultation’ (defined as having already conducted more than 3000 teleconsultations on Qare ® ) and categorized the teleconsultation duration as less or more than 5 minutes; these thresholds are routinely used as internal quality criteria on the Qare ® platform.…”