Shorter telemedicine visits for respiratory tract infections associated with antibiotic prescribing

The study of a direct-to-consumer telemedicine service found that visits for respiratory tract infections resulted in antibiotic prescriptions 67% of the time, nonantibiotics 13% of the time, and no prescription 20% of the time.

Telemedicine visits for respiratory tract infections (RTIs) took longer when the physician prescribed drugs other than antibiotics, compared to encounters offering antibiotics or nothing, a study found.

To determine whether prescribing was associated with length of encounter for RTI in a direct-to-consumer telemedicine service, researchers studied visits between January 2013 and August 2016. The brief research report was published on Oct. 2 by Annals of Internal Medicine.

The researchers included 13,438 encounters, 49% for sinusitis, 14% for pharyngitis, 12% for bronchitis, and 25% for other RTIs. Physicians prescribed antibiotics in 67% of encounters, nonantibiotics in 13%, and nothing in 20%. Rates of prescribing antibiotics ranged from 91% for sinusitis to 15% for other RTIs.

The mean unadjusted encounter length was 6.6 minutes when antibiotics were prescribed, 8.0 minutes when drugs other than antibiotics were prescribed, and 7.5 minutes when nothing was prescribed. Encounters where nothing was prescribed were 0.33 minute longer (95% CI, 0.13 to 0.53 minute) than those resulting in antibiotic prescriptions, while those resulting in prescription of nonantibiotics were 1.12 minutes longer (95% CI, 0.90 to 1.35 minutes). Visits for sinusitis and pharyngitis were shorter than those for bronchitis and other RTIs. The study authors noted that physicians' impressions that not prescribing antibiotics increases encounter length seem to be accurate, but the effect is small.

They wrote, “Although prescribing nonantibiotics has been suggested as a way to improve patient satisfaction while avoiding unnecessary antibiotic prescriptions, doing so seems to take more time than prescribing nothing. Of note, visits for bronchitis and other RTIs were longer than those for pharyngitis or sinusitis. This finding may highlight physicians' difficulty explaining why patients do not require treatment for these conditions.”