Antibiotic prescription trends shift due to telehealth during COVID-19

Fewer clinic visits resulted in a reduction in antibiotic prescriptions for acute respiratory infections, UTIs and skin and soft tissue infections in 2020 vs. 2019, according to findings presented virtually at the SHEA Spring Conference.

“With the emergence of COVID-19 in 2020, there was a rapid shift in primary and preventive care away from in-person visits and towards telehealth either by phone or video, and with this shift in modality, we wanted to assess changes in infectious diagnoses and antibiotic prescribing habits,” Brigid Wilson, PhD, a statistician at the VA Northeast Ohio Healthcare System in Cleveland, said during the presentation.

Wilson and colleagues used information from 13 community-based outpatient clinics in Veterans Health Administration databases to identify visits that included a diagnosis of acute respiratory infection, UTI or skin and soft tissue infection. The researchers compared the proportion of telehealth vs. in-person visits at monthly intervals and the proportion of patients who were prescribed antibiotics. Wilson said the researchers “focused on April through December of each year to account for seasonality.”

There was a higher proportion of visits conducted via telehealth for each type of infection from April 2020 to December 2020 vs. April 2019 to December 2019. According to the researchers, 90% of visits in 2019 occurred in person vs. 33% in 2020.

The researchers also found that a lower proportion of patients were prescribed antibiotics in 2020, regardless of visit modality. For acute respiratory infection, 63% of patients received antibiotics in 2019 vs. 46% in 2020; for UTI, 46% of patients received antibiotics in 2019 vs. 38% in 2020; and for skin and soft tissue infections, 65% of patients received antibiotics in 2019 vs. 47% in 2020.

“Antibiotic prescribing rates for acute respiratory infections and skin and soft tissue infections were higher for in-person visits than with telehealth visits. With the change in modality, antibiotics were prescribed in a smaller proportion of visits for these common diagnoses in 2020 than in 2019,” Wilson said. “So, in this primary care and preventive medicine outpatient setting, we observed a reduction in the proportion of visits for common infectious diagnoses that included an antibiotic prescription that occurred with the emergence of COVID-19.”