Does Telemedicine Lead to Overprescribing?
The important role that antibiotics have come to play in modern health care is undeniable. But as instances of antibiotic-resistant infection continue to arise, it has become abundantly clear that antibiotic overuse can present danger to patients—and as one new study highlights, the use of telemedicine could be making the problem a bit worse. As Consumer Reports first noted, a study published in the most recent issue of the journal Annals of Internal Medicine found that, when visiting providers via telemedicine for outpatient respiratory tract infections (RTIs), patients who had telemedicine visits were likelier than those who saw their doctors in person to receive prescriptions for antibiotics. “Overall, telemedicine encounters are much shorter than in-person doctor visits,” Dr. Kathryn A. Martinez, the study’s lead author and a Cleveland Clinic internal medicine researcher, told Consumer Reports. “And our research shows an association between the length of your encounter and the likelihood of receiving a prescription for antibiotics.”
The researchers, all of whom are based at the Cleveland Clinic, examined data from more than 13,000 telemedicine visits to treat outpatient RTIs such as sinusitis and bronchitis. About 67 percent of the encounters resulted in a prescription; as the study’s abstract notes, “outpatient RTIs rarely warrant antibiotics, although they are frequently prescribed.” What’s more, visits that led to the prescribing of an antibiotic were also shorter than those during which antibiotics were not prescribed. “These are very small differences in very short encounters in which every minute counts,” lead author Martinez told Consumer Reports. “But for the telemedicine physicians, who are getting paid by the volume of patients they treat, even a small increase in the time of each encounter can be a detriment.” Martinez encouraged patients to prepare for telemedicine encounters by carefully taking note of their symptoms, and noted that they can always feel free to ask questions of their health care providers, including about prescriptions, even if it means making the visit a bit longer. “If you have questions, it’s okay to push back,” she explained.
This isn’t the first time that researchers have sounded the alarm about antibiotic prescribing practices during telemedicine encounters. In 2015, for example, a RAND Corporation study that compared telemedicine visits to face-to-face encounters for acute respiratory infections found that, although both sets of patients were equally likely to receive a prescription for antibiotics, those who had telemedicine visits were likelier to be prescribed broad-spectrum, or less targeted, antibiotics. “The pattern of treatment offered to patients who saw a physician face-to-face vs. those who spoke with a physician on the telephone was not substantially different,” RAND’s Lori Usher-Pines, the study’s lead author, said in a press release at the time. “However, we found the antibiotics prescribed during telemedicine ‘visits’ raised some specific quality concerns that require further attention.” Similarly, a 2012 study from researchers at the University of Pittsburgh School of Medicine and UPMC examined more than a year’s worth of data for patients being treated for urinary tract infections (UTI) and sinusitis, with some utilizing e-visits and the others traditional in-person consults. The data demonstrated a higher rate of antibiotic prescription for those who visited with their doctors electronically.
