Background: Direct-to-consumer (DTC) telemedicine has become part of mainstream medicine, but questions exist regarding the quality of care provided. We assessed antibiotic stewardship, one measure of quality, by comparing antibiotic prescriptions for two groups of patients treated by telemedicine, one group via a telemedicine treatment pathway for low acuity ED patients and another group in the DTC telemedicine pathway.
Methods: We conducted a cross-sectional analysis comparing antibiotic prescriptions for patients diagnosed with acute respiratory infection (ARI) treated via telemedicine while physically in one of two urban EDs (Express Care) vs. those treated via telemedicine using the DTC application. Patients in both groups were seen by the same board-certified ED faculty group working dedicated telemedicine shifts. Visits for patients 18+ years with physician coded ICD-10 diagnoses corresponding to ARI between 11/2016 and 12/2018 were included. For patients with multiple visits only the initial visit was included. An antibiotic prescription was defined as oral or parenteral antibacterial medication. Comparisons were made before and after adjustment for age, sex, and diagnosis.
Results: During the study period there were 418 Express Care visits and 330 DTC telemedicine visits. Antibiotics for ARIs were prescribed for 39% of Express Care visits and 61% of DTC visits (OR 3.59; 95% CI 2.65-4.86; P<0.000). This finding did not materially change after adjustment for age sex and diagnosis (adjusted OR 3.59; 95% CI 2.65-4.87; P<0.000).
Conclusion: Antibiotic prescribing by the same group of physicians varied by telemedicine service line. Patients seen by telemedicine over a DTC platform were more likely to be prescribed antibiotics for ARI than those seen by telemedicine while physically in the ED. This work is consistent with other research of antibiotic stewardship in DTC telemedicine and demonstrates different practice patterns by the same physician group when providing care via different telemedicine service lines. Contextual factors unrelated to the video-based evaluation should be investigated for their role in contributing to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.