Bakhit Mina, Baillie Emma, Krzyzaniak Natalia, van Driel Mieke, Clark Justin, Glasziou Paul, Del Mar Christopher
Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
BJGP Open. 2021 Dec 14;5(6). doi: 10.3399/BJGPO.2021.0106. Print 2021.
Antibiotic overprescribing is a major concern that contributes to the problem of antibiotic resistance.
To assess the effect on antibiotic prescribing in primary care of telehealth (TH) consultations compared with face-to-face (F2F).
DESIGN & SETTING: Systematic review and meta-analysis of adult or paediatric patients with a history of a community-acquired acute infection (respiratory, urinary, or skin and soft tissue). Studies were included that compared synchronous TH consultations (phone or video-based) to F2F consultations in primary care.
PubMed, Embase, Cochrane CENTRAL (inception-2021), clinical trial registries and citing-cited references of included studies were searched. Two review authors independently screened the studies and extracted the data.
Thirteen studies were identified. The one small randomised controlled trial (RCT) found a non-significant 25% relative increase in antibiotic prescribing in the TH group. The remaining 10 were observational studies but did not control well for confounding and, therefore, were at high risk of bias. When pooled by specific infections, there was no consistent pattern. The six studies of sinusitis - including one before-after study - showed significantly less prescribing for acute rhinosinusitis in TH consultations, whereas the two studies of acute otitis media showed a significant increase. Pharyngitis, conjunctivitis, and urinary tract infections showed non-significant higher prescribing in the TH group. Bronchitis showed no change in prescribing.
The impact of TH on prescribing appears to vary between conditions, with more increases than reductions. There is insufficient evidence to draw strong conclusions, however, and higher quality research is urgently needed.
抗生素过度处方是一个主要问题，它导致了抗生素耐药性问题。
评估与面对面（F2F）咨询相比，远程医疗（TH）咨询对基层医疗中抗生素处方的影响。
对有社区获得性急性感染（呼吸道、泌尿系统或皮肤及软组织）病史的成人或儿童患者进行系统评价和荟萃分析。纳入了在基层医疗中将同步TH咨询（电话或视频）与F2F咨询进行比较的研究。
检索了PubMed、Embase、Cochrane CENTRAL（创刊至2021年）、临床试验注册库以及纳入研究的引用文献。两位综述作者独立筛选研究并提取数据。
共识别出13项研究。一项小型随机对照试验（RCT）发现，TH组抗生素处方相对增加25%，但差异无统计学意义。其余10项为观察性研究，但对混杂因素控制不佳，因此存在较高的偏倚风险。按特定感染进行汇总时，没有一致的模式。六项鼻窦炎研究（包括一项前后对照研究）显示，TH咨询中急性鼻-鼻窦炎的处方明显减少，而两项急性中耳炎研究显示处方显著增加。咽炎、结膜炎和尿路感染在TH组的处方略高，但差异无统计学意义。支气管炎的处方没有变化。
TH对处方的影响似乎因疾病而异，增加的情况多于减少的情况。然而，目前尚无足够证据得出有力结论，因此迫切需要开展更高质量的研究。
