TY  - JOUR
AU  - Gao, Yu
AU  - Magin, Parker
AU  - Tapley, Amanda
AU  - Holliday, Elizabeth
AU  - Dizon, Jason
AU  - Fisher, Katie
AU  - van Driel, Mieke
AU  - Davis, Joshua S
AU  - Davey, Andrew
AU  - Ralston, Anna
AU  - Fielding, Alison
AU  - Moad, Dominica
AU  - Mulquiney, Katie
AU  - Clarke, Lisa
AU  - Turner, Alexandria
PY  - 2025
DA  - 2025/3/13
TI  - Prevalence of Antibiotic Prescribing for Acute Respiratory Tract Infection in Telehealth Versus Face-to-Face Consultations: Cross-Sectional Analysis of General Practice Registrars’ Clinical Practice
JO  - J Med Internet Res
SP  - e60831
VL  - 27
KW  - antimicrobial resistance
KW  - antibiotics stewardship
KW  - telehealth
KW  - general practice
KW  - registrars
KW  - acute respiratory tract infection
KW  - antibiotics
KW  - prescription
KW  - respiratory tract infection
KW  - RTIs
KW  - Australia
KW  - consultations
KW  - teleconsultation
KW  - teleconsult
KW  - bronchitis
KW  - sore throat
KW  - acute otitis
KW  - sinusitis
KW  - in-consultation
KW  - upper respiratory tract infection
AB  - Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. Objective: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). Results: A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). Conclusions: GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship. 
SN  - 1438-8871
UR  - https://www.jmir.org/2025/1/e60831
UR  - https://doi.org/10.2196/60831
DO  - 10.2196/60831
ID  - info:doi/10.2196/60831
ER  -