That could be because it’s easier for GPs to ignore pressure for unnecessary antibiotics during remote consultations, and there’s less reliance on ‘just in case’ prescriptions, researchers say.
Remote GP consultations could help reduce unnecessary antibiotic use, according to new research that found lower rates of antibiotic prescribing among doctors who are keen telehealth users.
Doctors who were “intensive” adopters of telemedicine during and after the covid pandemic prescribed around 5% fewer antibiotics for respiratory tract infections compared to their peers, the Australian research shows.
While the use of telemedicine was tiny before covid, the number of telehealth consultations rapidly expanded during the pandemic and now accounts for around one in seven primary care consultations in Australia.
The researchers analysed telemedicine and antibiotic prescribing data among more than 36,000 GPs in 103 local areas before, during and after the covid pandemic.
“Our results so far suggest that GPs who adopted telemedicine more intensively reduced their antibiotic prescribing rates relative to less intense adopters without impacting their adherence to RTI [respiratory tract infection] prescribing guidelines,” the researchers wrote in the Journal of Health Economics.
“GPs who adopted telemedicine more intensively reduced their antibiotic prescription rates compared with low-intensity adopters.”
The researchers found that antibiotic prescription rates per 100 patient consultations dropped by 0.6 scripts (5%) for GPs with above average telemedicine adoption intensity (high-intensity adopters) relative to GPs with below average adoption intensity (low-intensity adopters) after primary care telemedicine consultations became subsidised in Medicare.
“This effect is explained by both a relative increase in the number of consultations and a relative decrease in the total number of prescribed antibiotic scripts for high-intensity adopters, which also persist into the post-pandemic period,” the researchers said.
While the researchers couldn’t pinpoint the exact mechanisms, they said their results were consistent with previous evidence showing that GPs felt more pressure from patients to prescribe antibiotics – when not clinically indicated – in face-to-face settings.
Pressure from patients to prescribe antibiotics could be “less obtrusive” during telehealth appointments compared to in-person consultations, the researchers said.
“Increased physical remoteness could alleviate the real or perceived patient pressure that physicians feel in a face-to-face setting.”
Another potential reason could be that telemedicine makes it easier for GPs to arrange quick follow-up appointments, reducing rates of prescribing antibiotics “just in case”, they said.
And if patients have a wider choice of doctors – without being limited by geography – that could improve matches between patients and physicians, the researchers said.
The findings show that telehealth consultations could help reduce unnecessary prescribing of antibiotics, the researchers said.
Co-author Dr Maria Wisniewska, Associate Research Fellow at Deakin University, said the long-term impact of telemedicine on quality and safety “has been a largely unanswered question”.
“Our findings suggest that remote consultations can actually support more appropriate antibiotic use, which is a critical public health priority,” Dr Wisniewska said.
“This study helps build the evidence base for how telemedicine can be safely integrated into routine care and provides much-needed data as we consider the future of primary health and telemedicine services.”
The researchers acknowledged that video and phone appointments “are not perfect substitutes for face-to-face consultations and telemedicine limits the scope of conducting detailed physical examinations”.
“Hence, clinicians may face more challenges in diagnosing and treating patients in other areas of care than those studied in this paper.”
