Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 7, 2023
Date Accepted: May 9, 2024
Antibiotic Prescribing by Digital Healthcare Providers as Compared to Traditional Primary Healthcare Providers: a Register study
ABSTRACT
Background:
Direct-to-consumer (DTC) telemedicine” increases worldwide and is changing the map of Primary Health Care (PHC). Virtual care has increased for the last decade and by the ongoing Covid-19 epidemy, patients’ use of virtual care has increased even further. In Sweden, Virtual care meetings are a part of the government supported healthcare today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided in a virtual setting. Antibiotic prescribing is a common treatment in primary health care.
Objective:
To compare antibiotic prescribing between digital primary healthcare (PHC) providers (Internet-PHC) and traditional physical PHC providers (Physical-PHC), and to determine whether prescriptions for specific diagnoses differed between Internet-PHC and Physical-PHC appointments, adjusted for the effects of attained age, sex, and time relative to the COVID-19 pandemic
Methods:
Antibiotic prescribing data based on ATC codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. Prescriptions issued by Internet-PHC or Physical-PHC physicians were considered. Information on appointment date, staff category serving the patient, ICD-10 diagnosis codes, ATC codes of prescribed medicines, and patient age and sex was used.
Results:
A total of 160 238 healthcare appointments were registered, of which 18 433 led to an infection diagnosis. Antibiotics with the ATC codes J01A–J01X were prescribed in 9.3% of Physical-PHC appointments as compared to 6.1% of Internet-PHC appointments. In addition, 61.3% of Physical-PHC infection appointments resulted in antibiotic prescriptions, as compared to only 25.7% of Internet-PHC appointments. The odds ratio of receiving an antibiotic prescription during an Internet-PHC appointment was 0.23–0.39 as compared to a Physical-PHC appointment.
Conclusions:
Physicians prescribe far fewer antibiotics during Internet-PHC appointments than during Physical-PHC appointments.
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