JMIR Publications

ABSTRACT

Background:

Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs.

Objective:

This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for: common cold/upper respiratory tract infection (URTI), bronchitis, sore throat, acute otitis media, and sinusitis.

Methods:

A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing, multi-centre inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis employed univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was ‘antibiotic prescribed’ for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media respectively. The study factor/independent variable of interest was consultation type (telehealth or F2F).

Results:

A total 2392 registrars participated (response rate 93.4%). The proportions of problems/diagnoses that were telehealth were: overall, 26%; URTI/common cold, 41%; acute bronchitis, 26%; acute sore throat, 24%; acute otitis media, 4.3%; and acute sinusitis, 37%. Antibiotics were prescribed for: 51% (n=1,685) of sore throat problems/diagnoses, 6.9% (n=880) of URTI problems/diagnoses, 64%(n=1,140) of bronchitis problems/diagnoses, 61% (n=1,067) of sinusitis problems/diagnoses, and 73%(n=1,278) of otitis media problems/diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (Adjusted OR 0.69, 95% CI: 0.55-0.86, P=.001), URTI (Adjusted OR 0.64, 95% CI: 0.51- 0.81, P<.001) and otitis media (Adjusted OR 0.47, 95% CI: 0.26-0.84, P=.01). There were no significant differences for acute bronchitis (Adjusted OR 1.07, 95% CI: 0.79-1.45, P=.66) or acute sinusitis. (Adjusted OR 1.00, 95% CI: 0.76-1.32, P=.99).

Conclusions:

GP registrars are less likely to prescribe antibiotics for sore throat, URTI and otitis media when seeing patients by telehealth versus face to face. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study for telehealth consultations being associated with greater registrar antibiotic prescribing for ARTIs – and, thus, no deleterious effect on antibiotic stewardship.