Children's National Study Ties Telehealth to Better Antibiotic Stewardship

A telehealth platform that includes clinical decision support tools can help care providers reduce inappropriate antibiotic prescribing rates, according to a study conducted at Children’s National Hospital.

The study, published this week in the Journal of General Internal Medicine, found that providers using a virtual care platform with real-time access to their own prescribing statistics as well as practice-wide statistics reduced their prescribing rates. That would help reduce the estimated 2.8 million antibiotic resistant infections that occur each year in the US.

“Telemedicine has the potential for even more inappropriate antibiotic prescribing than brick-and-mortar facilities because doctors aren’t physically examining patients and may not have the tools to accurately diagnose bacterial infections, such as looking in a patient’s ears to diagnose an ear infection, or performing a throat swab to accurately diagnose strep throat,” Rana Hamdy, MD, MPH, MSCE, an infectious diseases specialist and director of the Antimicrobial Stewardship Program at Children’s National, said in a press release.

The study focused on more than 55,000 visits conducted in 2018 by 45 physicians at the hospital for treatment of one of four target conditions: bronchitis, sinusitis, pharyngitis and upper respiratory tract infections. Halfway through the study period, the physicians were divided into two groups, with one half receiving education about appropriate antibiotic prescriptions and the second receiving that education as well as feedback on their telemedicine dashboard.

According to the study, antibiotic prescribing rates dropped for both groups after education, with the decrease more pronounced in the group that had telehealth access to prescribing data.

Hamdy, whose team included researchers from Boston Medical Center, the Stanford University School of Medicine, the Antibiotic Resistance Action Center at the George Washington Milken Institute of Public Health and Doctor on Demand – the telehealth company whose platform was used in the study – said the project points to the value of telehealth in giving clinicians access to important clinical decision support tools at the point of care.

The study also counters a 2019 report that indicated physicians using telehealth to treat children with cold symptoms tend to overprescribe antibiotics. The difference may be in how antibiotic stewardship is addressed on connected health platforms.

“We hope these results elevate the importance of antibiotic stewardship for quality of care and that all direct-to-consumer companies rise to the occasion to implement effective antibiotic stewardship interventions in their practice,” Hamdy said, noting that Doctor on Demand has added the prescribing statistics feature to its physician dashboard.