MedicalResearch.com Interview with:
Dr. Kathryn A. Martinez PhD MPH
CanSORT Cancer Surveillance and Outcomes Research Team
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Most upper respiratory infections are viral and therefore should not be treated with antibiotics. Despite this, physicians commonly prescribe them for these conditions. Patients often expect antibiotics for respiratory tract infections. As a result, physicians may find it easier to give patients what they want rather than explain to them why antibiotics aren’t needed.
We hypothesized it also might be more time consuming for physicians to explain to patients why they don’t need antibiotics, which creates a further incentive to prescribe them. To explore this potential phenomenon, we used data from a large direct to consumer telemedicine system to assess differences in medical encounter length by prescription outcome for patients diagnosed with respiratory tract infections.
We found that encounters resulting in antibiotics were 0.33 minutes shorter than those that resulted in no prescriptions, supporting our hypothesis that prescribing an antibiotic takes less time than prescribing nothing.
MedicalResearch.com: What should readers take away from your report?
Response: The difference in time it takes to not prescribe an antibiotic versus prescribe one is small – less than half a minute. However, most telemedicine physicians are paid per encounter, making even small differences in encounter length important. Efforts to curb inappropriate antibiotic use for respiratory tract infections will have to account for incentives physicians have for prescribing them, including saving time.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We were unable to characterize the content of the medical encounters. Specifically, we don’t know how the physicians talked to patients about whether or not antibiotics were needed and how the patient responded. This is an important area for future research. Understanding what parts of these encounters take up the most time will be instructive in designing interventions to reduce unnecessary antibiotic prescribing.
I have no disclosures to report.
Martinez KA, Rood M, Jhangiani N, Boissy A, Rothberg MB. Antibiotic Prescribing for Respiratory Tract Infections and Encounter Length: An Observational Study of Telemedicine. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-2042
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