Antibiotic Prescribing for Acute Respiratory Tract Infections During Telemedicine Visits Within a Pediatric Primary Care Network

Ray, Kristin N.; Martin, Judith M.; Wolfson, David; Schweiberger, Kelsey; Schoemer, Pam; Cepullio, Christine; Iagnemma, Jennifer; Hoberman, Alejandro

doi:10.1016/j.acap.2021.03.008

Cited by 25 publications

(17 citation statements)

References 13 publications

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“…Of these, 3 were systematic reviews (SRs) [11][12][13] and 8 were non-randomized comparative studies. 8,10,[14][15][16][17][18][19] For additional information, 7 publications from the grey literature search [20][21][22][23][24][25][26] were also included. Altogether, 18 publications were included to address the research questions; of these, 7 were evaluation guidance documents being used in various countries to evaluate virtual care in primary care settings and 11 were evaluations of virtual care in primary care settings.…”

Section: Resultsmentioning

confidence: 99%

“…(2021) compared in-person care and virtual care using guideline-concordant antibiotic management for acute respiratory tract infections among pediatric patients. 19 Across the 6-month period, guideline-concordant antibiotic management occurred in 92.5% of virtual care visits and 90.7% of in-person visits (P = 0.004). Over time, guideline-concordant antibiotic management during virtual care visits increased from 88% to 97% between April and September 2020.…”

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 93%

“…Over time, guideline-concordant antibiotic management during virtual care visits increased from 88% to 97% between April and September 2020. 19 Han et al ( 2020) performed an SR that also reported on guidelineconcordant prescription rates or guideline-recommended prescribing rates (against local or national guidelines of the US) from 4 observational studies. Guideline-concordant antibiotic management for sinusitis and urinary tract infection demonstrated no significant differences between remote and face-to-face consultations.…”

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

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Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

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A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

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Section: Resultsmentioning

confidence: 99%

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 93%

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

See 1 more Smart Citation

Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

View full text Add to dashboard Cite

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“…Our findings are consistent with Ray et al, who found that guideline-concordant antibiotic prescribing was higher in telemedicine visits during the pandemic, and that overall prescribing was lower in telemedicine visits compared to inperson office visits. 23 Previous literature from the pre-COVID era has reported mixed results regarding antibiotic prescribing in telemedicine, although several key studies have reported increased prescribing at telemedicine encounters, particularly in direct-toconsumer telemedicine. [24][25][26] However, the COVID-19 pandemic represents the first period during which telemedicine was made widely available within primary care practices.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Antibiotic Prescribing in Pediatric Primary Care

Dutcher

Lee³

et al. 2022

Pediatrics

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BACKGROUND AND OBJECTIVES: With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric ambulatory encounter volume and antibiotic prescribing both decreased; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. METHODS: We conducted a retrospective observational study to assess the impact of the COVID-19 pandemic and associated public health measures on antibiotic prescribing in 27 pediatric primary care practices. Encounters from January 1, 2018, through June 30, 2021, were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients. Interrupted time series analysis was performed. RESULTS: There were 69 327 total antibiotic prescriptions from April through December in 2019 and 18 935 antibiotic prescriptions during the same months in 2020, a 72.7% reduction. The reduction in prescriptions at visits for respiratory tract infection (RTI) accounted for 87.3% of this decrease. Using interrupted time series analysis, overall antibiotic prescriptions decreased from 31.6 to 6.4 prescriptions per 1000 patients in April 2020 (difference of −25.2 prescriptions per 1000 patients; 95% CI: −32.9 to −17.5). This was followed by a nonsignificant monthly increase in antibiotic prescriptions, with prescribing beginning to rebound from April to June 2021. Encounter volume also immediately decreased, and while overall encounter volume quickly started to recover, RTI encounter volume returned more slowly. CONCLUSIONS: Reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained, only beginning to rise in 2021, primarily driven by reductions in RTI encounters. Reductions in viral RTI transmission likely played a substantial role in reduced RTI visits and antibiotic prescriptions.

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“…Children were more likely to receive antibiotics during telemedicine visits (52.0%) than during emergency room visits (42.0%) or visits to their pediatrician (31.0%). Antibiotics were prescribed according to current recommendations in 92.5% of telemedicine visits, and in 90.7% of office examinations (p = 0.004) [31,32].…”

Section: Telemedicine and The Administration Of Antibiotics In The Ag...mentioning

confidence: 99%

Rational use of antibiotics during the COVID-19 pandemic

Milovanović¹,

Jotić²,

Radin³

et al. 2021

Srpski medicinski časopis Lekarske komore

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Introduction/Aim: The global COVID-19 pandemic has long been considered an emergency, with the number of cases growing exponentially, despite constant efforts to control the infection. Although the disease is caused by the SARS-CoV-2 virus, most patients are treated with antibiotic therapy. The long-term effects of such broad antibiotics use on antimicrobial resistance are still unknown and are a matter for concern. The aim of this paper is: to determine, based on the available literature, the impact of the COVID-19 pandemic on the use of antibiotics; to determine the global situation regarding antimicrobial resistance; to identify key areas where urgent changes are needed. Methods: A systematic review of the current literature on the use of antibiotics in COVID-19 treatment was conducted. The PubMed and MEDLINE databases were searched for papers published between March 2020 and September 2021. Results: Between 76.8% and 87.8% of patients with COVID-19 were treated with antibiotics. Antibiotics were less frequently prescribed to children, as compared to adults (38.5%, compared to 83.4%). The most commonly administered antibiotics were fluoroquinolones (20.0%), macrolides (18.9%), b-lactam antibiotics (15.0%), and cephalosporins (15.0%). Self-medication with antibiotics to prevent and treat COVID-19 has been identified as one of the important factors contributing to antimicrobial resistance. Conclusion: The impact of COVID-19 on global antimicrobial resistance is still unknown and is likely to be unevenly distributed in the general population. Although various antibiotics have been used to treat patients with COVID-19, their role and the need for their application in the treatment of this infection remains to be determined. For now, there are no reliable data as to whether the use of antibiotics in COVID-19 cases without associated bacterial infections has any effect on the course of the disease and mortality.

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Antibiotic Prescribing for Acute Respiratory Tract Infections During Telemedicine Visits Within a Pediatric Primary Care Network

Cited by 25 publications

References 13 publications

Approaches to Evaluations of Virtual Care in Primary Care

Approaches to Evaluations of Virtual Care in Primary Care

COVID-19 and Antibiotic Prescribing in Pediatric Primary Care

Rational use of antibiotics during the COVID-19 pandemic

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