Medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice: a retrospective observational study.

Nasir Wabe,Gorkem Sezgin,Andrew Georgiou,Muhammad Kashif Sheikh,Judith Thomas,Emma Gault

doi:10.3399/bjgpo.2021.0132

Abstract

BackgroundThere has been a precipitous rise in telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face consultations with telehealth during the COVID-19 pandemic in Australian general practice.Design & settingA multisite, retrospective observational study. De-identified routinely collected electronic health data were used, which were extracted from 806 general practices in Victoria and New South Wales (NSW), Australia, between April and December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data were reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) classification system level 1 groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13 608 216 consultations satisfied the inclusion criteria (61.0% face to face and 39.0% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication, which is a statistically significant difference (adjusted odds ratio [OR] 1.38, 95% confidence interval [CI] = 1.379 to 1.381). The prescribing rate was greater for face-to-face versus telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared with telehealth consultations in the study population.

Highlights

Under COVID-19 restrictions in the states of Victoria and New South Wales (NSW), Australia, medication prescribing was higher in face-to-face consultations when compared with telehealth consultations in the study population
There is a paucity of quantitative evidence regarding differences between face-to-face and telehealth consultations during the pandemic, for medication prescribing
This large multisite observational study of 806 general practices in two Australian states found a statistically significant difference in medication prescribing between face-to-face and telehealth consultations, with 6.3% more prescriptions issued in face-to-face consultations

Summary

Introduction

Since the World Health Organization (WHO) declared COVID-19 (the disease caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2 ]) as a pandemic on 11 March 2020, within 15 months (11 June 2021) there were more than 174 million confirmed cases of COVID-1 9 and the tragic loss of more than 3.7 million lives[1] globally. Telehealth has been defined by the International Organization for Standardization as ‘the use of telecommunications techniques for the purpose of providing telemedicine, medical education and health education over distance‘,5 and telehealth consultation uptake has rapidly accelerated worldwide.[6] In general practice, primary care, and outpatient settings studies have reported decreases in the overall number of patient consultations,[3,7,8,9] decreases in face-to-face consultations,[3,7,8,9,10,11] and concomitant increases in telehealth and remote consultations,[3,4,8,9,10,11,12,13] with telephone consults more widely used than video.[3,4,8,10,13] While the expeditious shift towards telehealth consultations has provided accessibility to healthcare practitioners during periods of lockdown and restrictions, differences between the content of US primary care telemedicine and face-to-face consultations (for blood pressure and cholesterol assessments) during the pandemic have been reported.[11]. There is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances

Objectives

Methods

Results

Discussion

Conclusion