Physicians who meet with patients via direct to consumer telemedicine services are just as likely to prescribe antibiotics as those who conduct in-person visits, according to a study conducted by Rand Corporation. The study was published in The Journal of the American Medical Association (JAMA) Internal Medicine.
The study examined health plan claims from 1,725 patients who used telemedicine service Teladoc and 64,099 who went in for an office visit. Visits were covered by the California Public Employees' Retirement System (CalPERS).
"[Direct-to-consumer] telemedicine is often more convenient and less expensive than in-person visits," researchers explained. "However, concerns about the quality of these services have been expressed: lack of physician-patient relationship and access to medical records; limitation of the physical examination; and barriers to testing could lead to overuse of antibiotics."
Researchers analyzed health claims from users who were continuously enrolled in CalPERS from April 2012 to October 2013 and visited with a physician one or more times for an acute respiratory infection (ARI). They then compared Teladoc's antibiotic prescription rates against those of office visits.
They found that Teladoc users were less likely to be 51 or older and less likely to have one or more chronic illness. Researchers also found that the prescription rates for office visits and telemedicine visits were similar, in both an unadjusted analysis and adjusted analysis, which took into account sex, age, chronic illness, site of care, and ARI diagnosis. The adjusted antibiotic prescribing rate for ARI visits was 58 percent for Teladoc and 55 percent for office visits.
The researchers also added that both the office and telemedicine visit had "high rates of inappropriate prescribing" for conditions like bronchitis.
"When antibiotics were prescribed, Teladoc used more broad-spectrum antibiotics," they wrote. "This is concerning because overuse increases costs and contributes to antibiotic resistance. Greater use of broad-spectrum antibiotics may be driven by the tendency for physicians serving DTC companies to practice conservatively, with limited diagnostic information."
This data is especially interesting right now as Teladoc is currently embroiled in a legal battle with the Texas State Medical Board over restrictions that would keep Teladoc from practicing in Texas. One of the stated aims of the Texas Medical Board ruling was to "prevent overuse/abuse of drugs of any kind".