Association between antibiotic prescribing for RTIs and patient satisfaction in DTC telemedicine

Owing to the viral pathology of most outpatient respiratory tract infections (RTIs), antibiotics typically are not indicated for this condition but are often prescribed for it, anyway.

Owing to the viral pathology of most outpatient respiratory tract infections (RTIs), antibiotics typically are not indicated for this condition but are often prescribed for it, anyway. Some observers suspect that doctors fear lower rates of patient satisfaction if they do not prescribe the drugs, and researchers with the Cleveland Clinic thought direct-to-consumer telemedicine would provide an ideal setting in which to study this possibility. The team analyzed telemedicine encounters that occurred over a single platform between 85 physicians and their patients with sinusitis, bronchitis, or other RTI during January 1, 2013–August 31, 2016. Of 8,437 encounters, 66.1% ended with an antibiotic being prescribed; 18.3% ended with no prescription; and 15.5% ended with a nonantibiotic medication being prescribed. On a scale of 0–5, 87% of encounters received a 5-star rating; but the association was strongest with patients who walked away with an antibiotic prescription. More than 90% of them awarded 5 stars. Perfect scores were more common among recipients of nonantibiotic prescriptions (86%) vs. patients who left empty-handed (72.5%), suggesting that RTI sufferers prefer nonantibiotic medication over nothing at all. Based on the findings, the researchers speculate that prescribing nonantibiotic medications could improve satisfaction ratings without increasing unwarranted use of antibiotics. At the same time, counter-incentives may be need to reduce antibiotic prescribing in this setting.