Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Real-Time, Text-Based Primary Care
Keywords:Antibiotic Stewardship, Bronchitis, Machine Learning, Primary Care, Telemedicine
Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease Control and Prevention. Inappropriate use of antibiotics is cited as a key driver of antibiotic resistance. Despite this, both telemedicine and traditional in-person medical care struggle to meet national guidelines. This study evaluates antibiotic prescribing practices at 98point6, a Seattle-based provider of real-time, text-based primary care. This paper reviews a novel combination of machine learning with a physician-led virtual platform and smartphone interface to exceed published benchmarks for the avoidance of antibiotics in the treatment of bronchitis.
Design: This retrospective cohort study looks at patients ages 18–64 who were evaluated and treated using real-time, text-based care. Cases in which patients were diagnosed with “acute bronchitis/bronchiolitis” between December 1, 2019 and November 30, 2020 were analyzed. Visits were categorized by whether systemic antibiotics were or were not given.
Setting: This telemedicine provider provides service to patients ages 1 and above in all 50 states and the District of Columbia. The cohort that is present was drawn from that population.
Participants: A total of 1,238 consecutive patients ages 18–64 who presented for medical care during the time period.
Interventions: This is a retrospective cohort. No direct intervention was undertaken. Patients received standard care for the evaluation and treatment of upper respiratory symptoms.
Main Outcome Measures: The results are presented as descriptive statistics with demographic information and compared to published reports of appropriate antibiotic use for the treatment of bronchitis.
Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% compares favorably with published benchmarks from the National Committee for Quality Assurance and is significantly lower than rates in previously published samples for telemedicine, primary care, and urgent care.
Conclusion: Real-time text-based care resulted in a high rate of adherence to the established standard for the treatment of bronchitis, greatly exceeding benchmarks and published results from both telemedicine and in-person medical practice.
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Copyright (c) 2021 David McCune, James Pellegrin, Anshul Sachdeva, Roxana Cham, jessica Sollaccio, Sandra Giramahoro Coyne, Mark Stewart
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