May 20, 2022

Study raises questions about telehealth and overprescribing antibiotics

A new study has drawn attention to the overprescription of antibiotics by doctors during virtual appointments, despite the drugs’ failure to benefit patients with acute respiratory infections caused by viral infections.

The researchers found that third-party contract physicians were more likely to prescribe antibiotics to their patients for respiratory infections, compared to hospital-affiliated clinicians who offer a telehealth option. However, most respiratory infections are caused by viruses, which are not affected by these drugs.

Dr. Kathleen Li, an emergency physician at Michigan Medicine, was lead author on the study, which analyzed more than 250 telehealth visits to a large New York City health system from March 2018 to July 2019. Since then, Telehealth services have exploded as the pandemic has underscored the need to offer virtual appointments to patients.

Dr Li said his study shouldn’t be seen as a blow to telehealth, but rather as a reminder that not all telehealth is created equal.

“Overprescribing has been a problem long before telehealth,” Li said. “What this study highlights is not whether telehealth is more of a problem than in-person care. It’s that the type of telehealth, or who delivers the telehealth or how it’s delivered can affect prescription rates.

the study, published in the Journal of Telemedicine and Telecare, found that contract doctors prescribed antibiotics in 37% of visits related to acute respiratory infections, including colds, flu and bronchitis. This was compared to 18% for physicians affiliated with a hospital.

Antibiotics are effective at treating bacterial infections, but the vast majority of acute respiratory infections are caused by viruses, according to a report published in the Annals of Internal Medicine. Symptoms usually include stuffy or runny nose, cough, sore throat and/or low fever.

With few antiviral drugs available, the advice for respiratory infections caused by viruses is usually to get enough rest, stay hydrated, watch for symptoms, and give your body time to fight off the infection.

Li speculated that third-party providers may have prescribed more antibiotics during his study because they did not have access to the patient’s medical history and assumed the appointment was punctual, rather than a probable follow-up.

Meanwhile, system-affiliated clinicians who have a history with the patient and have access to their medical records may be more likely to follow up to see how their symptoms are improving before suggesting antibiotics.

Demand for telehealth grew 63-fold among Medicare users alone between 2019 and 2020, from about 840,000 visits in one year to 52.7 million, according to the US Department of Health and Human Services. Acute respiratory infections are one of the most common reasons patients seek virtual care.

Many Michigan health systems said they started offering virtual appointments before the pandemic, but the health crisis has accelerated the process of onboarding patients and doctors and made them feel connected. comfortable with this option.

Li could not offer any specific cost savings associated with hiring contractors for telehealth care, but said there are additional costs that a health system incurs when creating of its in-house virtual care options. She said it will be important for hospitals to weigh the costs and benefits of these options in the future.

“I hope health system leaders consider these trade-offs between quality and cost in terms of continuity of care and antibiotic management when deciding how to structure their telemedicine services,” she said. declared.

Overprescribing antibiotics in general can have repercussions. In addition to patient side effects like gastrointestinal problems or allergic reactions, such overprescribing increases the likelihood that other bacteria in the body will evolve into antibiotic-resistant strains.

In June 2020, the American College of Emergency Physicians highlighted the importance of avoiding antibiotics for unresponsive conditions and explaining to patients why a prescription might not be effective.

“Antibiotic resistance is kind of a growing threat to public health,” Li said. “We often have bacteria on our skin and in our gut; bacteria live everywhere. If you give antibiotics and don’t treat the infection, you may be affecting all the other bacteria and giving them a chance to evolve.

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