Antibiotics were prescribed as frequently among doctors providing care through telemedicine appointments as among physicians who saw patients face-to-face, a new study found. But the types of antibiotics prescribed via telemedicine were more expensive and could increase antimicrobial resistance.
The study, conducted by the RAND Corp., and published Tuesday in JAMA Internal Medicine, analyzed telemedicine appointments for 1,700 patients who received treatment for respiratory infections between April 2012 and October 2013 by provider Teladoc, and compared them with 64,000 patients who were treated at a doctor's office for the same condition.
Researchers found both treatment settings had high rates of prescribing antibiotics for treating acute respiratory infections, which has been estimated to not be clinically necessary in about half of all outpatient cases for the condition.
The study found that patients who used Teladoc services were prescribed antibiotics at a rate of 58%, compared with 55% at a doctor's office, suggesting there was little difference in the quality of care provided in both health settings.
Teladoc physicians, however, prescribed broad-spectrum antibiotics at a rate of 86%, compared with 56% at a doctor's office. Those types of antibiotics are used against a wide range of pathogens.
The study's lead author, Lori Uscher-Pines, a policy researcher at RAND, said the result suggests telemedicine physicians took a more conservative treatment approach because of limitations in getting a more precise diagnosis. Overprescribing of broad-spectrum antibiotics raises concerns that pathogens may develop resistance to those drugs, further limiting treatment options for antimicrobial illness.
The study suggested that telemedicine providers should consider quality-improvement initiatives that aim to change physicians' behavior relative to prescribing antibiotics.
Although the study implied that the overall quality of care provided by telemedicine physicians may be comparable to that found in doctors' offices, critics of telemedicine raise safety concerns that remote physicians may misdiagnose patients because of their inability to run laboratory tests or give a physical examination.
The debate over telemedicine has only intensified in recent years with the rising physician shortage. A recent analysis by market research firm RNCOS valued the telemedicine industry at around $14.8 billion in 2014, and expected it to grow at a compound annual growth rate of 18% up to 2020.
Last month, the Texas Medical Board voted in favor of limiting telemedicine practice in the state, requiring physicians to have an in-person visit with a patient before they are allowed to conduct a healthcare exam through telecommunication technologies, unless the patient is in a medical setting at the time of the initial telemedicine visit.
Few empirical studies have been conducted examining the issues of care quality and safety provided by telemedicine physicians.
“There has been, unfortunately, mostly anecdotal feedback on the quality of care delivered through telehealth,” said Jason Gorevic, CEO of Teladoc. “This is one of the few empirical sets of data analysis and demonstrates the high quality of care provided by Teladoc.”
