Identifying Virtual and In-Person Antibiotic Prescribing Behaviors Before and During the COVID-19 Pandemic

• Published in: Population health and epidemiology
• Main Authors: Wong, Sabrina, Morkem, Rachael, Barber, David
• Format: Text
• Language: English
• Published: American Academy of Family Physicians 2023
• Subjects: Population Health and Epidemiology; Canada; British Columbia; Newfoundland
• Online Access: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10549586/; https://doi.org/10.1370/afm.21.s1.3677

CONTEXT: The majority of antibiotic use in healthcare (90% by volume) occurs in the primary care setting, where, on average, 25% of antibiotic prescriptions are avoidable. Virtual care may lead to a reduction in the number of inappropriate antibiotic prescriptions. OBJECTIVE: To identify how antibiotic prescribing behavior changed over time during the COVID-19 pandemic in virtual versus in-person primary care visits. STUDY DESIGN AND ANALYSIS: Cross sectional cohort. We examined the proportion of visits that were virtual. For visits where an antibiotic was received, sorted by the following antibiotic indication groups: respiratory tract infections (RTI), skin/soft tissue (SSI), urinary tract infections (UTI) and other infections. DATASET: Canadian Primary Care Sentinel Surveillance Network electronic medical record data from sites across Canada in British Columbia, Alberta, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland. POPULATION STUDIED: The cohort was defined as any patient with a healthcare encounter between January 2019 and December 2020. OUTCOME MEASURE: Percent change in visits in 2020 compared to 2019, for all encounters, and for encounters with an antibiotic prescription, sorted by visit type (virtual versus in-person), and stratified by sex, age group and rurality. RESULTS: There were 901,649 patients with a visit during the 2019 study period, and 839,839 patients with a visit during the 2020 study period. Evaluating visits for these patients, we found that the there was a significant reduction in visits associated with an antibiotic in all indication groups: relative reduction of -38% for RTI, -3.9% for SSI, -2.6% for UTI, and -15.8% for other infections. Looking more closely at the type of visit reveals that in 2019, 2.5% of visits were virtual, compared to 33% in 2020. While the increase in virtual visits was consistent by sex, we found that there were significantly less virtual visits in children (0-18 years), compared to other age groups: 25.33% of all visits were virtual for 0-18 years, ...