A Call for Responsible Antibiotic Use in the Age of Telemedicine – The Health Care Blog - Latest Global News

A Call for Responsible Antibiotic Use in the Age of Telemedicine – The Health Care Blog

By PHIYEN NGUYEN

Telemedicine has revolutionized healthcare as we know it, but may also contribute to antibiotic overuse and antimicrobial resistance.

Antibiotics and the risks

Antibiotics treat infections caused by bacteria, such as strep throat and whooping cough. They do this by either killing bacteria or slowing their growth. Antibiotics save millions of lives around the world every year, but they can also be overprescribed and overused.

Overuse of antibiotics can lead to antimicrobial resistance (AMR). AMR occurs when germs from the initial infection continue to survive even after a patient has completed a course of antibiotics. In other words: The germs are now resistant to this treatment. Resistance to just one type of antibiotic can lead to serious complications and prolonged recovery, requiring additional treatments with stronger medications.

The Centers for Disease Control and Prevention reported that AMR results in over 2.8 million infections and 35,000 deaths each year in the United States. By 2050, AMR is expected to cause approximately 10 million deaths annually, resulting in a global public health crisis.

Increase in telemedicine and antibiotic prescriptions

Surprisingly, the growth of telehealth may contribute to overprescription and overuse of antibiotics.

Telemedicine exploded during the COVID-19 pandemic and today 87 percent of doctors use it regularly. Telemedicine allows patients to receive virtual healthcare via telephone, video or other forms of technology. It provides greater flexibility, reduced travel times and reduced risk of disease spread for both patients and providers.

Popular platforms like GoodRx and Doctor on Demand market convenient and easy access to healthcare. Others offer specialized services, such as WISP, which focuses on women’s health. Despite its benefits, telehealth is not perfect.

It limits physical exams (by definition) and relationship building, which alters the patient-provider relationship. It’s also unclear whether providers can truly make accurate diagnoses in a virtual environment in some cases.

Studies also show that antibiotics are prescribed more frequently during virtual consultations than during in-person visits.

For example, doctors were more likely to prescribe antibiotics for urinary tract infections during telemedicine appointments (99%) than during a physical visit (49%). In another study, 55 percent of telemedicine visits for respiratory infections resulted in antibiotic prescriptions, which later occurred in many cases not require them.

Online appointments with prescribed antibiotics were also shorter on average than in-person visits. Shorter in-person visits were associated with inappropriate antibiotic prescribing, raising a similar question about the quality of prescribing decisions during online visits. Additionally, referrals and follow-up appointments are less likely to occur with telemedicine than with in-person visits. So, after antibiotics are administered online, there may be less provider oversight than would otherwise be the case.

Worryingly, telemedicine providers were more likely to receive a 5-star rating from patients if they prescribed antibiotics. In other words, receiving a prescription could become an expectation. This could create an incentive for providers to prescribe unnecessary antibiotics in order to receive a higher rating. It could also lead patients to seek out providers who can provide the care (e.g., antibiotic prescriptions) they think they need.

What can we do?

Telehealth isn’t going away, but insurers, providers and patients are not helpless in the fight against antibiotic overuse.

First, insurance companies have influence and should ensure that antibiotics are prescribed for the right diseases. Insurers are well-positioned to review data trends on antibiotic prescribing practices, share this information with providers, and identify areas where resistance may be more prevalent. Insurers can also educate their members about antibiotic resistance and encourage more appropriate prescribing.

Providers should rely on antimicrobial management and antibiotic control programs aimed at monitoring antibiotic use and reducing AMR. These strategies include clinical education, auditing, and prior authorization for restricted antibiotics. They may be accompanied by cautious use of telehealth focused on improving access to care for vulnerable groups (e.g., low-income, non-English-speaking, and minority patients).

Patients also play a role. Online appointments are often viewed as mere transactions where a prescription is expected after payment. It is important that patients discuss their symptoms in detail during telemedicine appointments so that providers can offer the most appropriate treatment plan, which may or may not include antibiotics. Patients should also ask questions: Are antibiotics the first choice for treating my condition? What are the possible side effects? Are there alternative treatment methods?

Beyond the virtual exam room, we should continue to promote better hygiene practices, including thorough handwashing, which is essential to limiting bacterial resistance. To ensure the sustained effectiveness of these life-saving medications, it is essential to maintain a balance between accessibility and responsible antibiotic use.

The sharp contrast between the threat of antibiotic overuse and unhindered access through telemedicine raises questions about the unintended consequences of convenience. In the age of telemedicine, providers and patients alike need to know when antibiotics are truly necessary and when they are not.

PhiYen Nguyen, MPP, is a policy analyst at the Partnered Evidence-based Policy Resource Center at Boston University School of Public Health.

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