A new RAND Corporation study finds that doctors prescribing antibiotics in a telehealth encounter are more likely to resort to a broad-spectrum drug than in a face-to-face visit with a patient, leading to higher costs through over-use and antibiotic resistance.
The California-based study compared 1,700 patient visits for acute respiratory infection between April 2012 and October 2013 through Teladoc, a Dallas-based telehealth provider and one of the nation's largest, with 64,000 face-to-face visits. It found that patients treated via telehealth – either by video consult or phone – were just as likely to be prescribed an antibiotic as those who saw a doctor in person, but the doctor in the latter case tended to prescribe a more targeted drug.
“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,” Lori Usher-Pines, the study’s lead author and a policy researcher at RAND, said in a press release. “However, we found the antibiotics prescribed during telemedicine ‘visits’ raised some specific quality concerns that require further attention.”
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According to researchers, both treatment settings saw doctors inappropriately prescribing antibiotics for conditions like bronchitis on a regular basis, which they said is consistent with other studies that have indicated about half of all outpatient antibiotic prescriptions are unnecessary.
Rand researchers noted that broad-spectrum antibiotics tend to be used in larger quantities because they don't treat the issue as quickly or as effectively as a more targeted drug, and therefore lead to over-use and waste. In addition, patients who use such drugs more frequently could build up a tolerance to the antibiotic, eventually rendering the drugs useless.
The study, published online in JAMA Internal Medicine, is reportedly the first to compare the quality of direct-to-consumer telemedicine with in-person encounters for common acute respiratory infections. It suggests, researchers said, that doctors using telehealth tend to be more conservative in their diagnosis "based upon limited diagnostic information about their patients."
"The results suggest that telemedicine providers should consider quality-improvement initiatives to change physicians behavior, as well as direct education to patients to influence demand for unnecessary antibiotics, according to the study," RAND researchers said in the press release.
The study was supported by the California HealthCare Foundation. Along with Usher-Pines, those involved in the research were Andrew Mulcahy, Gerald Hunter and Rachel Burns of RAND, David Cowling of the California Public Employees’ Retirement System and Ateev Mehrotra of RAND and Harvard Medical School.
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