Telehealth lowered GPs’ antibiotic prescribing: Study

GPs who rapidly took up telehealth were 5% less likely to prescribe antibiotics than slower adopters, a ‘fascinating’ new study has found.
 
The findings, which were published this month in the Journal of Health Economics, identified high and low intensity adopters of telehealth.
 
Researchers then used MBS and Pharmaceutical Benefits Scheme data from 2017–22 to track their prescribing of antibiotics, which were mostly prescribed for respiratory tract infections, via telehealth.
 
The study aimed to assess whether telehealth affected the quality of prescribing antibiotics among GPs in Australia, finding a high rate of telehealth use was not linked to an increase in broad-spectrum antibiotics prescribing.
 
Although they did not make conclusions about the reasons behind the trend, researchers still say the results ‘are consistent with previous evidence showing that GPs feel more pressure from patients to prescribe antibiotics when not clinically indicated in face-to-face settings’.
 
More frequent consultations could also have had an effect, they suggest, saying ‘that more efficient time use may have led GPs to reduce reliance on antibiotics as a substitute for limited consultation time’.
 
They also said the results gave no suggestion high-intensity adopters were less likely to follow guidelines, and noted the results persisted over time with GPs’ practice styles potentially ‘permanently altered’.
 
RACGP Expert Committee – Quality Care Chair (REC–QC) Professor Mark Morgan called the research ‘fascinating’, noting the size of the study, which involved data relating to 36,669 GPs.
 
The researchers excluded GPs based in remote and very remote areas, as well as those in the top and bottom five percentiles of telehealth consultations conducted.
 
‘One important positive for this study is that antibiotic dispensing was used as an outcome measure rather than prescribing,’ Professor Morgan told newsGP.  
 
‘This means that ‘just in case’ or ‘delayed’ prescriptions were not counted, only those that were dispensed.’
 
He also noted researchers’ efforts to mitigate potential confounding factors such as the increase in the number of consultations among high-intensity telehealth users.
 
Dr Michael Tam, who also sits on the REC–QC, said he found the study interesting, but it was difficult to draw definitive conclusions given the background of the pandemic.
 
‘This was a really weird period for the telehealth presentations that might lead someone to prescribe an antibiotic,’ he told newsGP.
 
‘There was an absolutely massive drop in respiratory tract infections.
 
‘The reasons we saw the results they did, it’s hard to say exactly why. 
 
‘I feel at least gratified that Australian general practice didn’t devolve into obvious bad practice over that period of time.’
 
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