Graduate Assistant University of Florida College of Pharmacy Gainesville, United States
Background: Studies evaluating the quality of telemedicine based on oral antibiotic prescribing rates (APR) for acute self-limited infections have reported varying results. During the pandemic, telemedicine delivery expanded from specialized providers and select patient populations to a broad range of providers and patients, which might have affected quality including APR.
Objectives: To describe changes in the utilization of telemedicine for treatment of common infections during the COVID-19 pandemic and patterns of APR.
Methods: We used MarketScan Commercial Claims data (2018-2021) to identify sequential cohorts of children and adults with viral or unspecified bronchitis, upper respiratory infection (URI), acute sinusitis (AS), pharyngitis, and uncomplicated urinary tract infection (uUTI). To accurately capture the relative utilization of telemedicine versus in-person visits, we restricted our analyses to outpatient healthcare services that are authorized by Medicare for delivery via telemedicine or in-person visits. March 17, 2020 was used to define the start of the COVID-19 period and to reflect the Medicare telehealth coverage extension. Prevalence of telemedicine encounters and APR were summarized for pre- (04/2018-12/2018 and 04/2019-12/2019), early (04-12/2020), and late (04-12/2021) pandemic periods. Lower APRs indicate better prescribing practices.
Results: The prevalences of total outpatient encounters and APRs dropped during the early phase of the pandemic and rebounded thereafter: bronchitis (pre 2.4, early 0.6, late 1.3 per 1,000 enrollees and APR 67.6%, 58.4%, 60.7%), URI (7.1, 3.0, 7.1 and 35.6%, 22.8%, 24.9%), AS (7.0, 2.7, 5.1 and 78.9%, 73.6%, 74.1%), pharyngitis (7.4, 3.8, 6.7 and 44.2%, 32.2%, 32.4%). The proportion of telemedicine overall outpatient encounters were bronchitis (1.6%, 29.7%, 14.9%), URI (1.7%, 25.8%, 13.0%), AS (2.4%, 30.5%, 18.3%), pharyngitis (0.7%, 19.3%, 8.7%). Before the pandemic, the difference in APR between telemedicine vs in-person visits was negative for bronchitis (-20.6%), URI (-14.6%) and AS (-9.4%) but positive for pharyngitis (9.5%). During the pandemic, these differences narrowed across conditions with URI and AS flipping direction: bronchitis (early -2.4%, late period -0.2% ), URI (1.9%, 4.0%), AS (1.6%, 1.5%), pharyngitis (4.5%, 7.1%).
Conclusions: Differences in APRs between telemedicine and in-person visits varied in magnitude and direction across infection types and pandemic periods. During the pandemic, differences in APRs narrowed, potentially explained by increasing in similarity of prescribers and patients. Further studies assessing this new type of telemedicine are warranted.
