A new study by the Cleveland Clinic finds that clinicians tend to prescribe more antibiotics in virtual care visits than they do in person. Researchers say it's the fault of the platform, not the provider.
Healthcare organizations with robust virtual care programs should invest in antibiotic stewardship resources to prevent overprescribing, according to the results of a recent study.
The study, conducted by researchers at the Cleveland Clinic Health Systems and published in Oxford Academic, found that urgent care virtual visits for treatment of respiratory tract infections were far more likely to result in antibiotic prescriptions than the same visits conducted in person.
It's not the first study to suggest that providers using telehealth are more likely to prescribe medications. Some place the blame on providers, particularly those contracted by direct-to-consumer telehealth providers, saying they're more likely to prescribe to save time and seek higher reimbursements.
Others are disputing that suggestion, and the Cleveland Clinic study follows that route. Researchers there say the telemedicine platform may be at fault, as clinicians don't have the ability to see a patient in person to conduct a thorough analysis, which might rule out antibiotics or lead to a different treatment.
"To our knowledge, this is the first to attempt to isolate the role of the platform in antibiotic prescribing," the Cleveland Clinic team reported. "That we found higher prescribing in virtual care suggests that it is the limitations of the platform, and not the clinicians or the health system, that drive higher antibiotic prescribing."
The Cleveland Clinic team used EHR data to analyze 69,189 in-person visits and 19,003 virtual care visits for RTI treatment conducted by the health system between 2018 and 2022, with COVID-19 visits excluded. According to that data, 58% of the virtual visits led to an antibiotic prescription, compared to 43% of in-person visits. More specifically, 34% of the virtual care visits were diagnosed as sinusitis, and 95% of those led to a prescription, while only 13% of the in-person visits led to a sinusitis diagnosis, and 91% of those resulted in a prescription for antibiotics.
Many hospitals and health systems already include special training for clinicians who use virtual care. Studies like that conducted by the Cleveland Clinic are evidence that those programs should include protocols for virtual prescribing, monitoring of virtual prescribing habits, and antibiotic stewardship tools.
Eric Wicklund is the associate content manager and senior editor for Innovation at HealthLeaders.
KEY TAKEAWAYS
Several studies have found that virtual care providers often prescribe more medications than doctors treating patients in person. Some say the providers are at fault, while others say the telehealth platform is to blame.
Healthcare organizations with virtual care programs should make sure their providers are trained to prescribe via telehealth, and that monitoring and antibiotic stewardship tools are available.