Patient Satisfaction and Antibiotic Prescribing for Respiratory Infections by Telemedicine

Abstract

BACKGROUND AND OBJECTIVES: Respiratory tract infections (RTIs) are a common reason for direct-to-consumer (DTC) telemedicine consultation. Antibiotic prescribing during video-only DTC telemedicine encounters was explored for pediatric RTIs. METHODS: Encounter data were obtained from a nationwide DTC telemedicine platform. Mixed-effects regression was used to assess variation in antibiotic receipt by patient and physician factors as well as the association between antibiotic receipt and visit length or patient satisfaction. RESULTS: Of 12 842 RTI encounters with 560 physicians, antibiotics were prescribed in 55%. The provider was more likely to receive a 5-star rating from the parent when an antibiotic was prescribed (93.4% vs 80.8%). A 5-star rating was associated with a prescription for an antibiotic (odds ratio [OR] 3.38; 95% confidence interval [CI] 2.84 to 4.02), an antiviral (OR 2.56; 95% CI 1.81 to 3.64), or a nonantibiotic (OR 1.93; 95% CI 1.58 to 2.36). Visit length was associated with higher odds of a 5-star rating only when no antibiotic was prescribed (OR 1.03 per 6 seconds; 95% CI 1.01 to 1.06). Compared with nonpediatricians, pediatric providers were less likely to prescribe antibiotics (OR 0.44; 95% CI 0.29 to 0.68); however, pediatricians received higher encounter satisfaction ratings (OR 1.50; 95% CI 1.11 to 2.03). CONCLUSIONS: During DTC telemedicine consultations for RTIs, pediatric patients were frequently prescribed antibiotics, which correlated with visit satisfaction. Although pediatricians prescribed antibiotics at a lower rate than other physicians, their satisfaction scores were higher. Further work is required to ensure that antibiotic use during DTC telemedicine encounters is guideline concordant.

From Leather Bags to Webcams, the Emerging Tools of Tele-primary Care

“…10,12 This study and others suggest a relationship between receipt of a prescription and patient satisfaction. 12 In crowded markets with consumers sensitive to price and proxy indicators of quality such as 5-star reviews, companies are incentivized to optimize these levers to increase demand. In this study, Rastogi et al segmented review scores to 5-stars and less than 5 stars; 96% of respondents who received antibiotics gave a 5star review versus 85% of those who did not.…”

“…Literature on use of telemedicine for discrete conditions shows a trend toward overprescribing, generally less consistent guideline-concordant therapy, [8][9][10][11] varying appropriateness of diagnostic testing, 8,[10][11][12] and shorter follow-up intervals. 10,12 This study and others suggest a relationship between receipt of a prescription and patient satisfaction. 12 In crowded markets with consumers sensitive to price and proxy indicators of quality such as 5-star reviews, companies are incentivized to optimize these levers to increase demand.…”

Assessing the Impact of a Rapidly Scaled Virtual Urgent Care in New York City During the COVID-19 Pandemic

“…Overall, patient satisfaction results in our study indicated that the majority of patients were both satisfied and would use VUC again ( Figure 5). Patients from other centers asked to assess their experience with virtual evaluations in prior studies have similarly reported high rates of satisfaction outside a pandemic situation (27)(28)(29)(30).…”

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“…27,28 Other studies have demonstrated a strong positive correlation between patient satisfaction and an antibiotic prescription for upper respiratory tract infections (which are typically viral). 29,30 Examples like these demonstrate that financial pressures placed on physicians stemming from the interaction of their patient satisfaction evaluations and prescribing practices have the potential to contribute to grave public health crises such as the opioid epidemic and widespread antibiotic resistance. Strangely, physicians who oppose satisfaction-incentivized prescribing by practicing evidence-based medicine may be damaging their own interests.…”