JMIR Publications

ABSTRACT

Background:

There is growing interest internationally in using remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding safety of remote consultations is inconclusive. Appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed.

Objective:

To summarise evidence on the impact of remote consultation in primary care on antibiotic prescribing.

Methods:

Searches were conducted in MEDLINE, Embase, HMIC, PSYCINFO and CINAHL from their inception to February 2020. Peer-reviewed publications conducted in primary healthcare settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing. Studies were excluded if there were no comparison group (face-to-face consultations).

Results:

Thirteen studies were identified. Five studies demonstrated higher antibiotic prescribing rates in remote consultations compared to face-to-face consultations, three studies demonstrated lower antibiotic prescribing rate and two studies found no significant difference. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for sinusitis patients, but conflicting results were found for patients with acute respiratory infections.

Conclusions:

There is insufficient evidence to conclude confidently that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing in comparison with face-to-face consulting are a concern. Further well-conducted studies are needed to inform safe and appropriate implementation of remote consulting, to ensure that there is no unintended impact on antimicrobial resistance.