Revisiting last week's Teladoc antibiotic prescription study

By Jonah Comstock
10:16 am

JONAH_COMSTOCK_HEADSHOTLast week, JAMA Internal Medicine published a two-page research letter by the Rand Corporation that played into a national conversation about the efficacy of telemedicine -- specifically Teladoc, a company which is both about to IPO and embroiled in a potentially precedent-setting legal battle with its home state of Texas over whether the Texas Medical Board has the right to regulate the practice of telemedicine. (An early injunction by the court last week favored Teladoc.)

So it's perhaps no surprise that different people have read the Rand Corporation's findings in different ways.

While MobiHealthNews headlined our version of the story with the finding that telemedicine and in-person doctors prescribed antibiotics at roughly the same rate, other publications like Modern Healthcare focused on another finding in the study: that telemedicine doctors were more likely to prescribe broad-spectrum antibiotics. Still others, like mHealthNews, chose to lead with the relevant question: "Are doctors overprescribing via telehealth?"

Though at first glance the headlines might seem to disagree (some say the same amount of antibiotics are being prescribed, some say more) in fact none of them is wrong. So what does the study really say?

Overall, telemedicine and in-person doctors prescribe at similar rates. Teladoc doctors prescribed antibiotics to their patients about 58 percent of the time, compared to 55 percent at physician offices. The top three antibiotics prescribed were the same also: azithromycin, amoxicillin, and levofloxacin. This equivalence lends credence to the pro-telemedicine idea that telemedicine yields similar results to in-person healthcare.

In cases where antibiotics were prescribed, Teladoc doctors were more likely to prescribe broad-spectrum antibiotics. This is the main point some have chosen to focus on from the study, since it highlights the one area in which telemedicine could present a danger to society. Broad-spectrum antibiotics are a "safer bet" in that they're more likely to be effective, particularly for a patient about whom a doctor has limited information, so it makes sense that telemedicine doctors might gravitate towards them. But they're also bigger contributors to antibiotic resistance, which means they add to the risk of "superbugs".

Telemedicine and in-person doctors prescribed antibiotics for different diagnoses. Doctors from Teladoc were more likely than in-person doctors to prescribe antibiotics for pharyngitis and bronchitis, while the in-person doctors were more likely to prescribe them for upper respiratory infections and nasopharyngitis. Also, Teladoc users were more likely to be younger and less likely to have a chronic disease than in-person patients. That said, the study adjusted for age and chronic conditions when calculating the antibiotic statistics. The authors also point out that acute respiratory infection diagnoses are subjective enough that the diagnosis could sometimes be selected based on the treatment, not vice versa.

All that said, this one study falls as neither an affirmation nor a broad condemnation of telemedicine in general or Teladoc in particular, and it's unlikely to give either side much ammo in the pending legal battle. Mostly it gives telemedicine companies, if they'll take it, a little advice on a way in which they can shore up their medical practice.


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