Antibiotic prescription rates similar, often inappropriate, for telemedicine and office visits
Both settings had high rates of inappropriate prescribing for conditions such as bronchitis, raising concerns about increased health care costs and antibiotic resistance, a study found.
Antibiotic prescribing rates for acute respiratory infections were similar between a direct-to-consumer telemedicine health care clinician and physicians in their offices, with both settings having high rates of inappropriate prescribing for conditions such as bronchitis, a study found.
Researchers compared antibiotic prescribing rates for acute respiratory infections between a direct-to-consumer clinician (Teladoc, offered beginning in April 2012 as a covered benefit by the California Public Employees' Retirement System) and physician offices. Patients were 18 to 64 years old and enrolled from April 2012 to October 2013 and had 1 or more visits for an acute respiratory infection. Researchers looked at the number of oral antibiotic prescriptions within 3 days of the visit and defined broad-spectrum antibiotics as macrolides and fluoroquinolones.
Results were published in a Research Letter by JAMA Internal Medicine on May 26.
The adjusted antibiotic prescribing rate for all visits for acute respiratory infections was 58% for telemedicine versus 55% at physician offices (P=0.07). Telemedicine patients were more likely to receive antibiotics for pharyngitis and bronchitis and less likely to receive them for upper respiratory infections and nasopharyngitis, the study reported.
The most common antibiotics prescribed were azithromycin (58% for telemedicine vs. 45% for physician offices), amoxicillin (27% for telemedicine vs. 29% for physician offices); and levofloxacin (3% for telemedicine vs. 5% for physician offices). The adjusted rate of prescribing a broad-spectrum antibiotic was 86% for telemedicine versus 56% at physician offices (P<0.01).
When antibiotics were prescribed, the telemedicine clinicians used more broad-spectrum antibiotics, the researchers noted. “This is concerning because overuse increases costs and contributes to antibiotic resistance,” they wrote. “Greater use of broad-spectrum antibiotics may be driven by the tendency for physicians serving DTC [direct-to-consumer] companies to practice conservatively, with limited diagnostic information. DTC companies can work to lower rates through targeted quality-improvement initiatives to change physician behavior (e.g., timely feedback), as well as direct education to patients to influence demand.”