Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Nov 3, 2020
Date Accepted: Jan 31, 2021
Structured eVisits and antibiotic prescribing following sore throat, dysuria, or respiratory symptoms in primary care: An observational study
ABSTRACT
Background:
Direct-to-consumer telemedicine is an increasingly utilized 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:
To investigate if eVisit management of sore throat, other respiratory symptoms or dysuria leads to higher rates of antibiotic prescription compared to 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 healthcare provider in Sweden. Data were analyzed to compare antibiotic prescription rates within three days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n = 289 eVisits, n = 125 office visits) Centor Criteria data were manually extracted and validated.
Results:
Antibiotic prescription rates were lower following eVisits compared to office visits for sore throat (21.2% vs. 39.7%, P < .001) and respiratory symptoms (1.6% vs. 19.9%, P < .001), while no significant differences were noted comparing eVisits to office visits for dysuria (76.7% vs. 73.0%, P = 0.254). Guideline recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (96.4% vs 94.4% P = 0.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline recommended antibiotics (96.3% vs. 74.0%, P = 0.015 and 99.3% vs 94.4%, P < .001, respectively). Odds ratios of antibiotic prescription following office visits compared to eVisits were similar after adjusting for age and differences in set diagnoses (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 over-prescription of antibiotics compared to office visits. Clinical Trial: The study was registered at clinicaltrails.gov (Identifier: NCT03474887).
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