Vendor-supplied physicians prescribe antibiotics more often during telehealth visits
Vendor-supplied physicians prescribed antibiotics during telehealth visits more than twice as often as emergency physicians affiliated with medical centers, according to a study.
“This started out as a quality improvement project. Mount Sinai, where I trained, piloted an on-demand telehealth service for employees and their beneficiaries,” Kathleen Y. Li, MD, MS, an emergency physician at Michigan Medicine, told Healio.
“We decided to take advantage of the fact that the calls were staffed by affiliated emergency physicians at some times and third-party contractor-based physicians at other times to examine differences in care,” she said. “We looked at antibiotic prescribing in acute respiratory infections (ARIs) because ARIs are the most common complaints and there are clear clinical guidelines regarding antibiotic appropriateness for example, they’re not needed in upward of 90% to 95% of ARIs, and that’s being generous.”
Li and colleagues performed a retrospective analysis of on-demand telemedicine visits available to health system employees and dependents at a large urban academic health system between March 2018 and July 2019. According to the study, they performed multivariable logistic regression to determine the effect of physician affiliation on antibiotic prescribing patterns for ARI, adjusting for patient age, visit weekday and overnight visits.
The study included 257 telemedicine encounters related to ARIs. During these, affiliated physicians prescribed antibiotics in 18% of visits, compared with 37% of visits in which vendor physicians prescribed them.
An adjusted analysis revealed that patients seen by a vendor physician for an ARI had 2.3 higher odds (95% CI, 1.1-4.5) of being prescribed antibiotics, which the researchers said yielded an average marginal effect of 15% (95% CI, 2%-29%).
“With the proliferation of standalone telemedicine companies, it’s important for patients and health system leaders to realize that who is providing the telemedicine service — and how it’s provided — matters,” Li said. “Our study didn’t specifically look into the reasons for this difference, but the fact that we found such a big difference means we should be paying attention. There is a temptation to lump all of telehealth together, but there are better and worse (or higher and lower value) ways to implement it.”
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