The Agency for Healthcare Research and Quality (AHRQ), in conjunction with NORC at the University of Chicago and Johns Hopkins Medicine, created the AHRQ Safety Program for Telemedicine: Improving Antibiotic Use to develop and implement a bundle of evidence-based interventions designed to improve telemedicine care, focusing on reducing inappropriate antibiotic prescribing in primary and urgent care practices, including telemedicine practices, across the United States. Building on AHRQ’s pioneering work using Comprehensive Unit-based Safety Program (CUSP) methods to reduce healthcare-associated infections (HAIs) and improve antibiotic use across multiple healthcare settings, this program aims to develop a culture of patient safety and improve communication and teamwork while implementing interventions to improve antibiotic use within a telemedicine setting.
Infection-related complaints account for a large proportion of telemedicine visits. Two-thirds of telemedicine visits for upper respiratory tract infections inappropriately result in antibiotic prescriptions. Among the most common diagnoses treated in direct-to-consumer telemedicine visits are upper respiratory infections and sinusitis (35–85% of overall visits) and urinary tract infections (9–12% of overall visits).[1-4] Telemedicine offers unique challenges to the appropriate prescribing of antibiotics, such as lack of established therapeutic relationships, inability to perform a complete physical exam, lack of access to diagnostic testing, and limited infrastructure to implement antibiotic stewardship interventions.
[1] Martinez KA, Rood M, Jhangiani N et al. Patterns of use and correlates of patient satisfaction with a large nationwide direct to consumer telemedicine service. J Gen Intern Med. 2018;33:1768–73.
[2] Martinez KA, Rood M, Jhangiani N et al. Association between antibiotic prescribing for respiratory tract infections and patient satisfaction in direct-to-consumer telemedicine. JAMA Intern Med. 2018;178:1558–60.
[3] Jain T, Mehrotra A. Comparison of direct-to-consumer telemedicine visits with primary care visits. JAMA Netw Open. 2020;3:e2028392.
[4] Ray KN, Shi Z, Gidengil CA, Poon SJ et al. Antibiotic prescribing during pediatric direct-to-consumer telemedicine visits. Pediatrics. 2019;143:e20182491.
Recruitment for this program has ended.