October 01, 2018
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Patients prescribed antibiotics for respiratory infections had shorter telemedicine visits, gave better ratings

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Telemedicine visits for respiratory tract infections were shorter and had higher patient satisfaction ratings when antibiotics were prescribed, according to studies published in Annals of Internal Medicine and JAMA Internal Medicine.

Encounter length

“Outpatient respiratory tract infections rarely warrant antibiotics, although they are frequently prescribed,” Kathryn A. Martinez, PhD, MPH, from Cleveland Clinic, and colleagues wrote in Annals of Internal Medicine. “Because patients often expect to receive antibiotics, physicians may believe that explaining why they are unnecessary is more time-consuming than simply prescribing them.”

Martinez and colleagues investigated how antibiotic prescription receipt is affected by length of direct-to-consumer telemedicine encounters for respiratory tract infections.

The researchers examined 13,438 telemedicine encounters that were completed between January 2013 and August 2016 for sinusitis (49%), pharyngitis (14%), bronchitis (12%) or other respiratory tract infection (25%). They documented prescription outcomes as none, antibiotic or nonantibiotic for each encounter. The telemedicine system automatically recorded the encounter length in minutes when patients were connected to physicians.

Data indicated that antibiotics were prescribed in 67% of encounters, nonantibiotics were prescribed in 13% and no drugs were prescribed in 20%. Prescriptions for antibiotics were highest for sinusitis (91%) and lowest for other respiratory tract infections.

The mean unadjusted telemedicine encounter length was significantly shorter when antibiotics were prescribed (6.6 minutes), compared with nonantibiotics (8 minutes) and no drugs (7.5 minutes). The adjusted analysis revealed that encounters in which no drug was prescribed were 0.33 minutes longer (95% CI, 0.13-0.53) and those in which nonantibiotics were prescribed were 1.12 minutes longer (95% CI, 0.9-1.35) than those in which antibiotics were prescribed.

Telemedicine encounters were shorter for sinusitis and pharyngitis than bronchitis and other respiratory tract infections. Physicians visiting with older patients took 0.62 minutes longer than when visiting with patients aged 18 to 29 years.

“Physician impressions that not prescribing antibiotics increases encounter length seem to be accurate, but the effect is small,” Martinez and colleagues concluded. “Because telemedicine encounters are short and physicians are often reimbursed by encounter volume, antibiotic stewardship efforts that lengthen visits even slightly may be challenging to implement.”

Patient satisfaction

Physicians may frequently prescribe antibiotics for respiratory tract infections because they assume that patient satisfaction will be higher if they do, but evidence is unclear, Martinez and colleagues wrote in JAMA Internal Medicine.

Martinez and colleagues assessed telemedicine visits for respiratory tract infections from Jan. 1, 2013 to Aug. 31, 2016 to investigate how antibiotic prescribing affects patient satisfaction ratings.

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Visit outcomes were labeled as either no prescription, antibiotic prescription or nonantibiotic prescription. Participants used a zero to five stars scale to rate their satisfaction with their physician, with five stars indicating the most satisfaction.

The researchers identified 8,437 telemedicine encounters for respiratory tract infections, including sinusitis, pharyngitis, bronchitis or other respiratory tract infection. Physicians prescribed an antibiotic during most visits (66.1%), whereas they prescribed a nonantibiotic medication during 15.5% and no prescription during 18.3%.

Overall, participants rated their satisfaction as five stars for 87% of visits. For encounters in which no prescription was given, 72.5% were rated as five stars. For encounters in which an antibiotic was prescribed, 90.9% were rated as five stars. For encounters in which a nonantibiotic was prescribed, 86% were rated as five stars.

Receipt of an antibiotic prescription (adjusted OR = 3.23; 95% CI, 2.67-3.91) and nonantibiotic prescription (aOR = 2.21; 95% CI, 1.8-2.71) were strongly linked to a five-star satisfaction rate, compared with receipt of no prescription. There was a range in physicians’ mean adjusted rates of antibiotic prescribing range from 19% to 90%. Adjusted satisfaction ratings were associated with adjusted antibiotic prescribing rates (Pearson correlation = 0.41; P < .001).

“In direct-to-consumer telemedicine, antibiotic prescribing for respiratory tract infections is common, and patients who receive antibiotics for respiratory tract infections are more satisfied,” Martinez and colleagues concluded. “Prescribing nonantibiotic medications may improve satisfaction ratings without increasing unwarranted use of antibiotics, yet counter-incentives may also be required to reduce antibiotic prescribing in this setting.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.