Antibiotic Prescribing Practices During Telehealth Visits for Patients Presenting with Upper Respiratory Infections

Description: Telehealth services are drastically expanding throughout the health care sector, driven by the need for cost savings, more convenient and accessible care, and more recently during the COVID-19 pandemic, safer options for patients to connect with their health care providers. Despite the rapid growth, there are questions about the quality and effectiveness of virtual visits, especially as it relates to antibiotic prescribing. Some estimates show that 30% of all antibiotics prescribed in the outpatient setting are inappropriate. However, it is still largely unclear what differences, if any, exist in antibiotic stewardship and prescribing practices between telehealth and in-person visits.

Methods and analysis: In this literature review antibiotic prescribing practices for upper respiratory infections between telehealth and in-person visits are compared and contrasted. The results of seven retrospective research articles published within the last five years were included in the review, accounting for more than one million patient visits for acute upper respiratory infections.

Results: Results were mixed on whether antibiotic utilization and prescribing practices differed between telehealth and in-person visits. There was evidence to suggest that telehealth visits may result in either increased or decreased antibiotic prescribing, depending on institution type (private versus teaching), provider years since graduation, practice culture, patient expectation, type of infection, and provider specialty. However, one study suggested that virtual visits may adhere more closely to antibiotic prescribing guidelines. In certain infections, like sinusitis, there was either no significant difference in antibiotic prescribing or decreased antibiotic utilization in the virtual setting. This review adds to the body of evidence that antibiotic utilization may be less related to visit setting and more related to outside factors and helps demonstrate health care can be delivered virtually without compromising patient care.

Learning outcome and conclusion: Evidence is inconclusive as to whether antibiotic prescribing rates for patients presenting with acute upper respiratory infection differ when comparing in-person versus telehealth visits. Technology will continue to alter the way providers deliver health care. Therefore, further research is needed to assess patient outcomes and quality of care in virtual versus in-person settings as telehealth continues to expand offering patients more convenient and accessible health care.