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Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care : Observational Study

Entezarjou, Artin LU orcid ; Calling, Susanna LU ; Bhattacharyya, Tapomita ; Milos Nymberg, Veronica LU ; Vigren, Lina LU ; Labaf, Ashkan LU ; Jakobsson, Ulf LU orcid and Midlöv, Patrik LU orcid (2021) In JMIR Medical Informatics 9(3).
Abstract

BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.

OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.

METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were... (More)

BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.

OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.

METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.

RESULTS: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.

CONCLUSIONS: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JMIR Medical Informatics
volume
9
issue
3
article number
e25473
publisher
JMIR Publications Inc.
external identifiers
  • scopus:85103615287
  • pmid:33720032
ISSN
2291-9694
DOI
10.2196/25473
language
English
LU publication?
yes
id
025e4c47-f9b4-4e4b-bc76-fa66b27fab42
date added to LUP
2021-03-18 09:01:00
date last changed
2024-04-04 01:48:00
@article{025e4c47-f9b4-4e4b-bc76-fa66b27fab42,
  abstract     = {{<p>BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.</p><p>OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.</p><p>METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.</p><p>RESULTS: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P&lt;.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P&lt;.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P&lt;.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.</p><p>CONCLUSIONS: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.</p>}},
  author       = {{Entezarjou, Artin and Calling, Susanna and Bhattacharyya, Tapomita and Milos Nymberg, Veronica and Vigren, Lina and Labaf, Ashkan and Jakobsson, Ulf and Midlöv, Patrik}},
  issn         = {{2291-9694}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{3}},
  publisher    = {{JMIR Publications Inc.}},
  series       = {{JMIR Medical Informatics}},
  title        = {{Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care : Observational Study}},
  url          = {{http://dx.doi.org/10.2196/25473}},
  doi          = {{10.2196/25473}},
  volume       = {{9}},
  year         = {{2021}},
}