Antimicrobial Prescribing in the Telehealth Setting: Framework for Stewardship During a Period of Rapid Acceleration Within Primary Care

Abstract

Antibiotic resistance is a global public health threat. The use of telehealth in primary care presents unique barriers to antimicrobial stewardship, including limited physical examination and changes to the patient-provider relationship. Since the COVID-19 pandemic, there is a need to identify novel antimicrobial stewardship strategies with an explosion in the use of telehealth within primary care. Our review proposes a tailored, sustainable approach to antimicrobial prescribing in the telehealth setting based on the CDC’s Core Elements of Outpatient Antibiotic Stewardship: commitment, action for policy and practice; tracking and reporting; and education and expertise. The rapid growth of telehealth for all types of primary care visits (not just antibiotic use) is outpacing knowledge associated with strategies for antimicrobial stewardship. Improving antibiotic use within primary care settings is critical as telehealth will remain a priority whether the COVID-19 pandemic recedes, particularly within patient populations with limited access to healthcare.

Global Strategies to Combat Antimicrobial Resistance: A One Health Perspective

“…These programmes focus on promoting the appropriate use of antimicrobials in hospital settings, including prescribing guidelines, monitoring AMU, and education of HCWs [126]. Alongside this, some outpatient AMS programmes focus on promoting the appropriate use of antibiotics in outpatient settings, including clinics and doctor's offices [128] [129] [130]. These activities typically involve the education of HCWs, patients and the monitoring of antimicrobial prescribing patterns [112] [131] [132].…”

The Potential Effects of Implementing an Antibiotic Stewardship Program by Integrating It with Medication Therapy Service in a Low-Income Serving Clinic - A Single-Center Experience

“…Second, recent studies have proposed the framework of effective implementation of ASP through telehealth services. 31 , 32 Therefore, health care policyholders can advance policies, funding, and telehealth communications to enhance the provision of antibiotic stewardship services in low-income serving clinics or underserved areas.…”

Influence of climate change on emerging pathogens and human immunity

“…52 Unnecessary antibiotic prescriptions have also increased with the rise of telemedicine because of the COVID-19 pandemic raising the risk for more antibiotic resistance. 60 Higher temperatures and extreme weather events together with the rise of infections affect human health leading to more hospitalization with subsequent exposure to antibioticresistant bacterial strains. 61…”