Third-party physicians prescribe more antibiotics via telehealth than hospital-affiliated physicians


During the COVID-19 pandemic, demand for telemedicine has skyrocketed – a 63-fold increase among Medicare users alone, from approximately 840,000 telehealth visits in 2019 to 52.7 million in 2020.

As more and more people flocked to telemedicine, healthcare systems and increasingly implemented direct-to-consumer telehealth to provide convenient and safe options for acute care. But it was unclear how these services varied in terms of quality of care.

A new study found that for telemedicine visits related to acute respiratory infection, physicians provided by contractors prescribed antibiotics to patients almost twice as often as emergency physicians employed by the hospital system.

The vast majority of acute respiratory infections are viral and antibiotics just don’t help. On top of that, antibiotics have side effects for patients, including gastrointestinal problems and allergic reactions, and from a general public health perspective antibiotic resistance is a growing concern. Even if it doesn’t harm that individual patient, it can potentially impact everyone’s vulnerability to resistant strains.”

Kathleen Li, MD, MS, senior article author and emergency physician, Michigan Medicine

Acute respiratory infection covers a range of conditions, including colds, flu, and bronchitis. They are one of the most common reasons patients seek virtual care, accounting for about a third of all direct-to-consumer telehealth visits.

The research team analyzed more than 250 on-demand telemedicine visits available to employees of a large academic healthcare system from March 2018 to July 2019. Visits were either provided by emergency physicians affiliated with the system, or by doctors with mixed specialties employed by a third party. service provider.

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,” says Li.

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 a “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 likely ineffective, however, because more than 90% of patients who present to providers with an acute 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 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.”

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.


Michigan Medicine – University of Michigan

Journal reference:

Li, KY, et al. (2022) Differences in antibiotic prescribing rates for telemedicine encounters for acute respiratory infections. Journal of telemedicine and telecare.

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