Antibiotic Usage in Telemedicine vs Face to Face Visit

A new study published in the May edition of JAMA Internal Medicine performed by the RAND Corporation demonstrated that antibiotic prescribing rates for acute respiratory infections were similar between direct-to-consumer telemedicine and direct interaction in physician offices.

The California Public Employees Retirement System has offered Telacoc as a benefit since 2012. The authors of the study enrolled patients 18-64 over a 19 month period who were seen 1 or more times for the diagnosis of acute respiratory illness. They then compared antibiotic prescribing rates for Teladoc and physicians’ offices. A total of 65,824 patients were enrolled (1725 Teladoc and 64,099 physicians’ offices).

What they found was that in both adjusted and unadjusted analysis, the fraction of acute respiratory illness visits at which an antibiotic was prescribed was similar and not statistically significant (58% for Teladoc vs 55% for physicians’ offices, p = .07). The most common antibiotics prescribed were similar, however, the adjusted “broad –spectrum antibiotic” prescribing rate (defined as macrolides and fluoroquinolones) was higher for Teladoc (86% for Teladoc vs 56% at physicians’ offices, p < .01).

This study comes as questions have been raised regarding the quality of care delivered by telemedicine when compared to traditional face-to-face office visits. Although the rates of prescribing were similar, researchers say the higher use of broad-spectrum antibiotics is concerning due to the higher drug costs and contribution to antibiotic resistance. The authors suggest consideration should be made for telemedicine quality improvement initiatives to physicians and direct to patient education to influence demand for unnecessary antibiotics.

Uscher-Pines, Lori PhD, MSc; et al.   JAMA Internal Medicine. May 26, 2015.

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