Entezarjou Artin, Calling Susanna, Bhattacharyya Tapomita, Milos Nymberg Veronica, Vigren Lina, Labaf Ashkan, Jakobsson Ulf, Midlöv Patrik
Center for Primary Health Care Research, Department of Clinical Sciences in Malmö/Family Medicine, Lund University, Malmö, Sweden.
Capio Go AB, Gothenburg, Sweden.
JMIR Med Inform. 2021 Mar 15;9(3):e25473. doi: 10.2196/25473.
Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.
The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.
Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.
Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.
The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.
ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.
直接面向消费者的远程医疗是一种越来越常用的获得初级医疗服务的方式。先前关于使用同步虚拟就诊进行评估的研究显示，抗生素处方率的结果不一，而关于使用基于异步聊天的电子就诊进行评估的研究则较为缺乏。
本研究的目的是调查与使用实体门诊的常规管理相比，通过电子就诊管理喉咙痛、其他呼吸道症状或排尿困难是否会导致更高的抗生素处方率。
从瑞典一家大型私立医疗保健机构获取了3847次电子就诊和759次针对喉咙痛、排尿困难或呼吸道症状的门诊就诊数据。对数据进行分析，以比较3天内的抗生素处方率、抗生素类型和做出的诊断。对于一部分喉咙痛就诊病例（160次电子就诊，125次门诊就诊），手动提取并验证了森托标准数据。
与门诊就诊相比，电子就诊后喉咙痛（169/798，21.2%，对比124/312，39.7%；P<0.001）和呼吸道症状（27/1724，1.6%，对比50/251，19.9%；P<0.001）的抗生素处方率较低，而在排尿困难方面，电子就诊与门诊就诊相比未发现显著差异（1016/1325，76.7%，对比143/196，73.0%；P=0.25）。喉咙痛电子就诊和门诊就诊后开具指南推荐抗生素的情况相似（163/169，96.4%，对比117/124，94.4%；P=0.39）。呼吸道症状和排尿困难的电子就诊更常开具指南推荐的抗生素（26/27，96.3%，对比37/50，74.0%；P=0.02和1009/1016，99.3%，对比135/143，94.4%；P<0.001）。在调整年龄和既定诊断差异后，门诊就诊后抗生素处方的比值比与电子就诊相比，喉咙痛为2.94（95%CI 1.99 - 4.33），呼吸道症状为11.57（95%CI 5.50 - 24.32），排尿困难为1.01（95%CI 0.66 - 1.53）。
与门诊就诊相比，使用异步电子就诊管理喉咙痛、排尿困难和呼吸道症状与抗生素的固有过度处方无关。
ClinicalTrials.gov NCT03474887；https://clinicaltrials.gov/ct2/show/NCT03474887
