Telemedicine guidelines reduce unnecessary prescriptions

Study shows that the adoption of specific care guidelines reduced the prescription of antibiotics and antimicrobials for COVID-19 patients

Editorial staff

In April 2020, the Infectious Diseases Society of America (IDSA) published a set of guidelines on the use of telemedicine to treat suspected cases of COVID-19. The recommendations were immediately adopted by the Telemedicine Center at Hospital Israelita Albert Einstein, headquartered in São Paulo.

In a study published in the journal Einstein (Sao Paulo), researchers from the organization analyzed every telemedicine encounter from between March 2020 and August 2021 to evaluate how well the international guidelines were adopted and followed.

While unnecessary drug prescriptions—primarily of antimicrobials—exceeds 75% worldwide for suspected and confirmed COVID-19 patients treated via telemedicine, this figure was below 1% at the Brazilian institution in the time period analyzed.

“The quality of care and safety for telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications,” wrote the authors.

The results were obtained by examining medical records, with several quality indicators taken into account. Physicians were given feedback based on their own metrics, with recommendations based on the IDSA guidelines.

The study included all adults treated with respiratory symptoms in the prior 14 days who sought telemedicine consultations in the period under analysis. All patients had suspected or confirmed COVID-19 or other respiratory tract infections.

Antibiotic prescriptions reduced

Of the 221,128 patients evaluated:

42,042 (19%) were confirmed to have a SARS-CoV-2 infection
104,021 (47%) were suspected of having COVID-19
75,065 (33%) received other diagnoses

The average patient age was 35 years. In total:

125,107 (85%) of patients were treated at home
2,552 (1.7%) were referred for non-urgent hospital care
17,185 (11%) were referred to the emergency room

The rate of antibiotic prescription in suspected and confirmed cases was 0.46% to 0.65%, while the rate for prescriptions without scientific evidence was between 0.01% and 0.005%.

The study concluded that guideline-based training and feedback for physicians from supervisors can lead to fewer prescriptions of antibiotics and antimicrobials for suspected or confirmed cases of COVID-19.

“The adoption of prescription-focused protocols may improve guideline adherence and reinforce the quality of care and safety in telemedicine encounters,” the authors concluded.

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