TY  - JOUR
AU  - Han, Seung Min
AU  - Greenfield, Geva
AU  - Majeed, Azeem
AU  - Hayhoe, Benedict
PY  - 2020
DA  - 2020/11/9
TI  - Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review
JO  - J Med Internet Res
SP  - e23482
VL  - 22
IS  - 11
KW  - remote consultations
KW  - antibiotic
KW  - primary health care
KW  - systematic review
KW  - consultation
KW  - telehealth
KW  - COVID-19
KW  - safety
KW  - prescription
AB  - Background: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective: This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods: Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results: In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions: There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance. 
SN  - 1438-8871
UR  - http://www.jmir.org/2020/11/e23482/
UR  - https://doi.org/10.2196/23482
UR  - http://www.ncbi.nlm.nih.gov/pubmed/33031045
DO  - 10.2196/23482
ID  - info:doi/10.2196/23482
ER  -