Patients were more satisfied with a virtual doctor's visit when they received a prescription for antibiotics, regardless of whether they actually needed the drug, according to a new JAMA study
The review of 8,437 direct-to-consumer telemedicine patient visits for respiratory tract infection with 85 physicians showed that about 66% led to an antibiotic prescription.
Cleveland Clinic researchers found that 72% of patients who didn't receive a prescription, 91% of those who received an antibiotic and 86% of those who received a nonantibiotic medication gave the doctor's visit the highest marks.
About 30% of outpatient antibiotic prescriptions are unnecessary, according to 2016 data from the Centers for Disease Control and Prevention. That's about 47 million prescriptions annually. Experts now think the number is actually higher and warn that antibiotic overuse and overprescribing is contributing to antibiotic resistance.
The new JAMA study focuses on virtual visits, but telemedicine isn't alone in potentially overprescribing antibiotics. A recent CDC-funded study analyzing 2014 data found that bronchitis, flu or asthma patients were incorrectly prescribed antibiotics in multiple care locations. The study found that 46% at urgent care centers, 25% in emergency departments, 17% in medical offices and 14% in retail clinics were incorrectly given antibiotics.
Outpatient RTIs often don't warrant an antibiotic prescription, but many physicians know that patients are happier if given those drugs. Researchers in the latest survey didn't see other patient or physician factors associated with patient satisfaction. Physicians that prescribed antibiotics at least half the time reached the top quartile.
The connection is potentially dangerous, particularly with the emphasis throughout the healthcare industry on improving patient engagement and experience. Providers who don't follow proper prescribing guidelines risk giving rise to antibiotic-resistant superbugs.
Telemedicine is seen as one way to contain costs when a trip to the emergency room or doctors office isn't necessary. However, if doctors in those settings are overprescribing, that can reverse some of those savings.
The dangers of overprescribing aren't limited to antibiotics. Opioid prescriptions skyrocketed over the past two decades, peaking in 2010 before efforts to reverse the trend. The CDC said that overdose deaths increased by 200% between 1999 and 2014 and another 28% between 2015 and 2016 alone. Some hospitals have feared that patient satisfaction surveys asking about pain management could prompt doctors to prescribe opioids unnecessarily. As a result, CMS has moved away from asking patients about those experiences.
Despite some successes in stopping the growth of opioid prescriptions, a recent report from researchers at the Mayo Clinic found that prescription rates remained level for commercially insured patients between 2007 and 2016.