May 20, 2022

Hospital-affiliated physicians prescribe fewer antibiotics via telehealth than third-party physicians

Of all ARI-related encounters, contract physicians prescribed antibiotics in 37% of visits, compared to 18% for hospital-affiliated clinicians. After adjusting for other factors, the researchers predicted a 15% difference between the two groups.

“One of the reasons the third-party telemedicine providers in our study may have prescribed more antibiotics is if they were practicing more conservatively because they did not have access to the patient’s record for additional context and were basing all treatment decisions on a single patient interaction,” Li said.

Although physicians affiliated with this study demonstrated better antibiotic stewardship, she says, prescribing rates are likely still too high.

In June 2020, the American College of Emergency Physicians called antimicrobial resistance “critical threat to public health and patient health in emergency departments in the United States and around the world. The organization stressed the importance of avoiding antibiotics for nonresponsive conditions and educating patients and caregivers about why a prescription may not be effective.

“It’s not even a problem specific to telemedicine or emergency medicine: emergency care, clinics, and primary care providers have all historically over-prescribed antibiotics,” she said. declared. “Socieally, patients often expect something tangible like a prescription after paying for a doctor’s visit.”

Determining whether an infection is viral or bacterial is not always easy, especially through a virtual visit. So, says Li, many doctors may prescribe antibiotics to be “safe” or because they feel the need to satisfy the patient.

She warned that antibiotics are probably ineffective, however, because more than 90% of patients coming to suppliers with a sharp cough have an illness caused by a virus.

The study took place before the COVID-19 pandemic and subsequent telehealth explosion. As more providers consider paying third-party telemedicine companies to cover virtual urgent care services, Li’s team fears this could further fragment care.

“In contrast, if telemedicine services are offered within the patient’s usual care setting, the physician providing the service would have access to all of their past information and would know to what extent a patient will be able to keep up and they might be less inclined to prescribe antibiotics when they are not needed,” she said. “Going forward, I hope health system leaders will consider these trade-offs between quality and cost in terms continuity of care and antibiotic management when deciding how to structure their telemedicine services.

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The research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number T32HL129974. The authors are solely responsible for the content, results, and conclusions of their paper, which do not necessarily represent the views of the NIH.

Other authors include Ka Ming Ngai, MD, MPH, Mount Sinai, Nicholas Genes, MD, Ph.D., NYU Langone Health.

Article quoted: “Differences in Antibiotic Prescribing Rates for Telemedicine Encounters for Acute Respiratory Infections”, Journal of Telemedicine and Telecare. DOI: 10.1177/1357633X221074503