While patients treated for an acute respiratory infection were as likely to be prescribed an antibiotic whether treated by telemedicine or in person, those who saw a doctor virtually were more likely to be prescribed a broad-spectrum antibiotic, according to a study from Rand Corp. published this week in JAMA Internal Medicine.
The antibiotics prescribed during telemedicine visits raised some specific quality concerns that require further attention, according to lead author Lori Uscher-Pines, a policy researcher at RAND.
The research examined about 1,700 patients visits with direct-to-consumer telemedicine provider Teladoc that were covered through a health plan offered by the California Public Employees' Retirement System. They were compared with about 64,000 patients who visited a doctor's office for a similar medical problem.
While the rates of prescribing were similar, the adjusted prescribing rate for broad-spectrum antibiotics such as azithromycin, amoxicillin and levofloxacin was 86 percent for Teladoc versus 56 percent at physician offices.
Previous research has found that half of outpatient antibiotic prescriptions are not clinically indicated. The higher prescribing rate of broad-spectrum antibiotics among Teladoc physicians is concerning because overuse increases costs and contributes to antibiotic resistance, according to an announcement. It could be an indication that the Teladoc physicians were practicing conservatively, based upon limited diagnostic information about their patients, the authors say.
They suggest that telemedicine providers consider quality-improvement initiatives to change physician behavior and better educate patients about when antibiotics are unnecessary.
The Texas Medical Board, which has been in a years-long feud with Teladoc, recently established a rule that doctors must examine patients in person before being allowed to order prescriptions for them.
The disagreement has been over the definition of an "in-person visit." The board originally called for a "defined" physician-patient relationship, but later conceded that the visit could be an interactive video encounter, though it still requires a trained medical professional be present with the patient. Such regulations are seen as a hurdle to the adoption of telemedicine.
To learn more:
- read the abstract
- find the announcement