Weill Cornell Medical College, New York, NY, USA.
Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
J Telemed Telecare. 2024 Jan;30(1):151-155. doi: 10.1177/1357633X211034994. Epub 2021 Sep 13.
Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department.
We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis.
We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53-3.25; < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65-3.77; < 0.001).
Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.
远程医疗通过实时视听会议使医生能够评估和治疗患者，是提供医疗服务的一种快速发展的模式。抗生素管理是护理质量的一个重要衡量标准，对直接面向消费者的远程医疗中急性呼吸道感染抗生素处方的研究结果喜忧参半。我们比较了两组通过远程医疗治疗的急性呼吸道感染患者的抗生素处方率：（1）通过直接面向消费者的远程医疗应用程序治疗的患者，（2）在急诊室内通过远程医疗治疗的患者。
我们纳入了 2016 年 11 月至 2018 年 12 月期间，年龄在 18 岁及以上、经医生编码的国际疾病分类第 10 版急性呼吸道感染诊断的直接面向消费者的远程医疗和急诊部远程医疗就诊患者。两组患者均由专门的远程医疗轮值的急诊部教职员工进行诊治。我们比较了直接面向消费者的远程医疗和急诊部远程医疗就诊前后，在年龄、性别和诊断方面进行调整后的抗生素处方率。
我们共确定了 468 例急性呼吸道感染就诊：191 例直接面向消费者的远程医疗就诊和 277 例急诊部远程医疗就诊。总体而言，抗生素的使用率为 47%（直接面向消费者的远程医疗就诊中为 59%，急诊部远程医疗就诊中为 39%；比值比 2.23；95%置信区间 1.53-3.25； < 0.001）。调整年龄、性别和诊断后，抗生素的使用比率仍存在显著差异（比值比 2.49；95%置信区间 1.65-3.77； < 0.001）。
对于急性呼吸道感染，由同一组医生诊治的患者通过直接面向消费者的远程医疗治疗比通过急诊部的远程医疗治疗更有可能被开抗生素。这项工作表明，与视频评估相比，上下文因素可能导致直接面向消费者的远程医疗就诊中抗生素管理的差异。
