Antibiotics more frequently prescribed in virtual versus in-person urgent care visits
More than half (58%) of virtual urgent care visits for respiratory infection resulted in an antibiotic prescription compared with 43% of in-person visits, with prescriptions largely driven by sinusitis diagnoses, a review within a single health system found.
Antibiotic prescriptions are more common with virtual versus in-person urgent care visits, even among physicians who provide care in both venues, a retrospective study showed.
Investigators used electronic health record data from Cleveland Clinic to identify patients with respiratory tract infections and determine if their visit resulted in an antibiotic prescription. The study included 69,189 in-person and 19,003 virtual urgent care visits between January 2018 and December 2022. Any patient diagnosed with COVID-19 was excluded from the study. Findings were published by Clinical Infectious Diseases on July 30.
Fifty-eight percent of virtual visits resulted in an antibiotic versus 43% of visits carried out in person. Virtual care visits made up just 22% of all the respiratory infection visits but accounted for 27% of antibiotics prescribed. Broken down by infection type, data showed sinusitis diagnoses were more than twice as common in virtual visits than in-person visits (36% vs. 14%) and were linked with high antibiotic prescribing in both settings (95% in person, 91% virtual). Virtual urgent care was positively associated with an antibiotic prescription (odds ratio [OR], 1.64; 95% CI, 1.53 to 1.75) compared with in-person care. A total of 39 physicians saw at least 25 patients in both settings, and these physicians were more likely to prescribe an antibiotic during virtual care compared with in-person care (OR, 1.71; 95% CI, 1.53 to 1.90). No association was seen between visit volume and clinicians' antibiotic prescribing rate in either setting.
Limitations included that researchers were unable to assess the appropriateness of antibiotic prescribing and could not account for patient expectations for antibiotics.
The authors hypothesized that the antibiotic prescription rates may have differed because clinicians are more inclined to diagnose patients with sinusitis when they see them in a virtual setting. Short visits, lack of a pre-existing relationship with the patient, and pressure to achieve high patient satisfaction scores may also contribute to overprescribing in virtual care, they added.
Although the mean rate of antibiotic prescribing was higher in virtual care, most of the variability in prescribing occurred at the clinician level, the researchers noted. “In both settings there were physicians who prescribed antibiotics to almost all their patients or to none of them,” they said.
Overall, “understanding whether this high rate of sinusitis diagnosis is patient- or clinician-driven is essential for curtailing excessive antibiotic provision via virtual urgent care,” the authors concluded.