Telemedicine versus in-person primary care visits for upper respiratory infections: Comparison of antibiotic prescribing

IntroductionAntibiotic resistance is a growing public health threat, resulting in challenges in effectively treating bacterial infections. Primary care providers account for the majority of antibiotic prescriptions, highlighting their critical role in antimicrobial stewardship. As telemedicine becomes more prevalent in primary care, there is limited data on how this shift has influenced antibiotic prescribing behavior. Our objective was to examine differences in antibiotic prescription rates for upper respiratory infections (URIs) between in-person and telemedicine appointments in a large primary care health system.MethodsIn this retrospective cohort study, we included patients 18 years and older treated in primary care clinics in the Greater Atlanta area from May 2020 to September 2023. Eligible encounters were billed with a diagnostic code related to URI. The main measures included patient demographics, insurance status, and visit modality. A multivariable logistic regression model evaluated differences in antibiotic prescriptions by visit type.ResultsThere were 33,008 (66%) in-person visits and 16,965 (33.9%) telemedicine visits, totaling 49,973 encounters. The average age of patients was 56.8 (SD 17.5) years, 67.1% patients were female, and 37.6% were Black. There were no significant differences in antibiotic prescribing between telemedicine and in-person appointments (adjusted odds ratio 1.00, 95% CI 0.14-4.86, <i>P</i> > 0.5).DiscussionRates of antibiotic prescribing did not differ significantly between in-person and telemedicine primary care visits for URI. As a healthcare quality indicator, this result provides evidence that in-person and telemedicine appointments are comparable modalities of patient care.