Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care: Observational Study

BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking. OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits. METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated. RESULTS: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively. CONCLUSIONS: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits. TRIAL REGISTRATION: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887