Telemedicine Visit Length—Is It Linked to Antibiotic Prescribing?

Telemedicine encounters in which antibiotics were prescribed for respiratory tract infections were only slightly shorter than those in which non-antibiotics, or nothing at all, were prescribed.

Advances in technology mean that clinician-patient encounters no longer must take place in person. Telemedicine, in which the parties interact via screens, has become a legitimate alternative to old-fashioned in-office visits. And while online visits may lack a few of the factors that might help providers make a diagnosis, they do provide one asset that can be useful in clinical studies—the precise recording of each visit length.

A team of scientists at the Cleveland Clinic decided to investigate the relationship between telemedicine visit length and antibiotic prescribing for patients who complained of respiratory tract infections (RTIs). They examined a total of 13,438 separate virtual visits between 2013 and 2016 encompassing nearly 12,000 patients in different age groups and living in different regions of the United States. The diagnoses included sinusitis (the most common, with almost half of visits resulting in this diagnosis), pharyngitis, bronchitis, and other respiratory illnesses.

The team discovered that antibiotics were prescribed during two-thirds of all telemedicine visits, despite ample evidence that they’re usually not needed in the case of RTIs; however, prescribing practices varied by visit length. Visits were an average of 6.6 minutes long when providers recommended antibiotics. When nothing was prescribed, visits averaged 7.5 minutes and when the provider prescribed a non-antibiotic such as a cough medicine, steroid, or antihistamine, visits averaged 8 minutes.

“Telemedicine visits are generally pretty short, so I don’t think the overall visit length had much to do with the RTI diagnosis,” Kathryn A. Martinez, PhD, MPH, an assistant professor at the Cleveland Clinic and author of the study, told Contagion®. “We did this study because we wanted to test the anecdotal theory that it’s easier, and thus quicker, to give a[n] RTI patient an antibiotic than explaining to the patient why they don’t need one. We found it did indeed take less time to prescribe an antibiotic than to prescribe nothing, which supports this theory. However, the total amount of time saved is small. Explaining to patients why they don’t need an antibiotic if one is not indicated is worth the extra time.”

As for the discovery that visits were longer when a non-antibiotic was prescribed than when nothing was prescribed, Dr. Martinez could only speculate about the reason. “It could be because the telemedicine physician had to explain more to the patient about what they were prescribing and why,” she said. “Patients also might have had more questions about non-antibiotic prescriptions.”

Differences in encounter length also were related to the type of physician assigned to the visit, the age of the patient, and even the area of the country where the virtual visit occurred. Emergency physicians are used to making quick assessments, which may be why their encounters were shorter than those involving internists or family medicine doctors. Older patients had longer virtual visits than younger ones, possibly because they may have had multiple complaints, been less technologically savvy, or simply had more time to talk. Conversational norms are not the same in all parts of the country, which could be why physicians in the West took more time with patients than those in the Northeast, where briskness is prized.

“We didn’t set out to study [geographical differences] specifically, so this is an area warranting further research, particularly as direct-to-consumer telemedicine continues to grow,” Dr. Martinez said.

Ms. Saloman is a health writer with more than 20 years of experience working for both consumer-and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.