Comparison of Diagnosis and Prescribing Practices Between Virtual Visits and Office Visits for Adults Diagnosed With Sinusitis Within a Primary Care Network

Abstract

Background Many antibiotics prescribed in the outpatient setting result from upper respiratory tract infections (URTIs); however, these infections are often viral. Virtual visits have emerged as a popular alternative to office visits for URTIs and may be an important target for antimicrobial stewardship programs. Methods This retrospective cohort study evaluated adult patients diagnosed with sinusitis treated within a single primary care network. The primary objective was to compare guideline-concordant diagnosis between patients treated via virtual visits vs in-office visits. Guideline-concordant bacterial sinusitis diagnosis was based on national guideline recommendations. Secondary objectives included comparing guideline-concordant antibiotic prescribing between groups and 24-hour, 7-day, and 30-day revisits. Results A total of 350 patients were included in the study, with 175 in each group. Patients treated for sinusitis were more likely to receive a guideline-concordant diagnosis in the virtual visit group (69.1% vs 45.7%; P < .001). Additionally, patients who completed virtual visits were less likely to receive antibiotics (68.6% vs 94.3%; P < .001). Guideline-concordant antibiotic selection was similar between groups (67.5% vs 64.8%; P = .641). The median duration of therapy in both groups was 10 days (P = .88). Patients completing virtual visits were more likely to revisit for sinusitis within 24 hours (8% vs 1.7%; P = .006) and within 30 days (14.9% vs 7.4%; P = .027). Conclusions In adult patients presenting with sinusitis, care at a virtual visit was associated with an increase in guideline-concordant diagnosis and a decrease in antibiotic prescribing compared with in-office primary care visits. Virtual visit platforms may be a valuable tool for antimicrobial stewardship programs in the outpatient setting.

Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

“…Most research has been conducted on data derived from synchronous virtual visits in American health care settings, where antibiotic prescription is historically higher [6], possibly due to a more market-controlled health care system with incentives for high patient satisfaction [7]. Consequently, there have been mixed results regarding antibiotic prescribing following virtual visits in various contexts [4,[8][9][10][11][12][13][14][15][16][17][18], with most studies focusing on urinary tract infections (UTIs) and upper respiratory infections. For example, depending on the health care provider, virtual visits for sinusitis have been associated with both higher [14] and lower [10,13] prescriptions rates compared with office visits.…”

“…Consequently, there have been mixed results regarding antibiotic prescribing following virtual visits in various contexts [4,[8][9][10][11][12][13][14][15][16][17][18], with most studies focusing on urinary tract infections (UTIs) and upper respiratory infections. For example, depending on the health care provider, virtual visits for sinusitis have been associated with both higher [14] and lower [10,13] prescriptions rates compared with office visits. Comparisons to urgent care settings often demonstrate lower prescription rates for virtual visits [8,9].…”

Chancen und Einsatzmöglichkeiten von Telemedizin in der Hals‑, Nasen- und Ohrenheilkunde bei der Bekämpfung von SARS-COV-2

“…In die Auswertung eingeschlossen wurden Fälle mit typischen Symptomen einer Infektion der oberen Atemwege. Es konnte kein signifikanter Unterschied hinsichtlich der leitliniengerechten Behandlung, insbesondere der Verschreibung von Antibiotika, festgestellt werden [30].…”

Digital Care Providers Antibiotic Prescribing Compared to Traditional Primary Healthcare: A Retrospective Database Study of 332,987 Healthcare Visits in Sweden.

“…One study showed that adult patients presenting with sinusitis, received a higher rate of guideline-concordant diagnosis and a lower prescription of antibiotics at virtual visits compared with in-o ce primary care visits. So, the virtual patients received more often an appropriate diagnosis of viral sinusitis, which implies a lower rate of antibiotic prescribing [27]. Other studies demonstrated no difference [28,29,30,31].…”

“…It is said that online doctors in Sweden are not as thorough as physicians in PHC in following STRAMA's guidelines and recommendations and therefore prescribe antibiotics more often [8,9]. However, there are studies indicating lower prescribing of antibiotics in remote consultations compared to face-to-face consultations [6,27]. One study showed that adult patients presenting with sinusitis, received a higher rate of guideline-concordant diagnosis and a lower prescription of antibiotics at virtual visits compared with in-o ce primary care visits.…”