A new study published in Annals of Internal Medicine reports findings by researchers who examined the potential association between the rate of antibiotic prescribing by physicians using telemedicine compared with not prescribing antibiotics for outpatients with respiratory-tract infections.

Lead author Kathryn A. Martinez, PhD, and her team, which included, but was not limited to, physicians associated with the Cleveland Clinic, Cleveland, Ohio, explored the idea held by prescribers that educating patients regarding antibiotics for respiratory tract infections is more time consuming than simply writing a prescription. Evaluating encounter lengths and prescribing outcomes were the primary objectives of their study. Respiratory antibiotic prescribing was the targeted focus because this is the most frequent reason patients turn to telemedicine, and encounter duration is easily timed with telemedicine platforms.

After evaluating the data on direct-to-consumer telemedicine encounters associated with respiratory tract infections (RTIs), researchers found that the longest visits were associated with encounters in which “nonantibiotics” were prescribed, and RTI encounters in which antibiotics were prescribed were significantly shorter than other encounters. In addition, many patient and physician characteristics were independently associated with visit length. Among the patient characteristics were sex, age, and region; and for physicians, specialty practice, setting, and region.

According to the researchers, “To our knowledge, our study is the first to assess the effect of nonantibiotic prescriptions on encounter length. 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.”  The authors explained, “Physician impressions that not prescribing antibiotics increases encounter length seem to be accurate, but the effect is small. Because telemedicine encounters are short and physicians are often reimbursed by encounter volume, antibiotic stewardship efforts that lengthen visits even slightly may be challenging to implement.”

The authors underscore that the strength of the study is the precision of the telemedicine system in recording the length of each encounter; however, they also note limitations that include the inability to determine the appropriateness of antibiotic prescribing and conflicting estimates of encounter associations found in other studies evaluating timed clinical encounters.

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