Telemedicine Patients Prescribed More Broad-Spectrum Antibiotics

Patients treated for an acute respiratory infection who saw a doctor virtually were more likely to be prescribed a broad-spectrum antibiotic, according to a new study.

Researchers at the RAND Corporation (RAND; Pittsburgh, PA, USA) studied about 1,700 patient treated for an acute respiratory infection from April 2012 to October 2013 by Teladoc (Dallas, TX, USA), one of the largest telemedicine providers in the United States. The patients were covered through a health plan that provides health insurance to California state public workers. The experiences of patients who used Teladoc were compared to about 64,000 patients who visited a doctor's office for a similar medical problem.

The results showed that while patients were as likely to be prescribed an antibiotic whether treated by telemedicine or in person, the adjusted prescribing rate for broad-spectrum antibiotics such as azithromycin, amoxicillin, and levofloxacin was 86% for Teladoc, versus 56% at physician offices. The researchers speculated that the higher use of broad-spectrum antibiotics could be a result of direct-to-consumer (DTC) companies practicing conservatively, based upon limited diagnostic information about their patients. The study was published on May 26, 2015, in JAMA Internal Medicine.

“Both treatment settings had high rates of inappropriate prescribing for conditions such as bronchitis, which is consistent with prior research that about half of outpatient antibiotic prescriptions are not clinically necessary,” said lead author Lori Uscher-Pines, PhD, a policy researcher at RAND. “We found the antibiotics prescribed during telemedicine 'visits' raised some specific quality concerns that require further attention.”

DTC telemedicine companies provide consumers with around-the-clock access to care for common non-emergent conditions through telephone and live video visits, using personal computers and mobile phone apps. Approximately one million DTC telemedicine visits were delivered in the US in 2014, the vast majority between patients and physicians that has no established relationship. One of the reasons cited for the growth in DTC telemedicine is the shortage of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the federal Affordable Care Act.

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RAND Corporation
Teladoc