When Dr. Fleming found penicillin mold in his Petri dishes in 1928, he had no idea of the impact he — and it — would have on global health. Penicillin and the antibiotic revolution that it triggered have saved countless lives and change world history.
Less than a century later, though, antibiotics occupy a space between savior and sinner. This complicated reputation is mostly due to how often they are prescribed unnecessarily and the superbugs that overuse has helped usher in. Physicians understand this dichotomy better than anyone. They’ve had front-row seats to cases of antibiotics saving lives, but they’ve also seen MDROs (multi-drug resistant organisms) like E. coli and staph infections that don’t respond to several rounds of intravenous treatment.
Those superbugs have huge clinical and financial ramifications. Researchers at Emory University and St. Louis University estimate that drug-resistant infections force the U.S. to spend an extra $2.2 billion on health care every year. Broken down by patient, that’s an extra $1,383 on every hospital bill.
The news about that impact hasn’t reached patients who insist the only thing that will help cure their cold is a round of “Gorilla-floxacillin.” And doctors feel the sting of a bad review, escalated complaint or in-person tirade when they try to do the medically correct thing. As online ratings and referrals have a greater impact on the ability of doctors and health systems to attract and keep patients, one bad review from one frustrated antibiotic seeker can reverberate louder than ever.
Can telehealth help?
Patient-facing, non-video telehealth platforms that incorporate evidence-based clinical content as part of their offering can help mitigate inappropriate use of antibiotics, as well as the patient pressure to prescribe them.
For example, let’s look at upper respiratory infections (URIs). Clinical best practices are clear that antibiotics are not prescribed for viral sinusitis, but for bacterial infections only. Determining the difference between viral and bacterial infections can make a huge difference in adherence to evidence-based medicine. The good news: That difference is largely algorithmic, and smart virtual care platforms can tell them apart.
Another bit of good news: Patients report high levels of satisfaction with the care they receive via telehealth. Deloitte found that 77 percent of users who have tried telehealth were satisfied with their experience. A JAMA study found even higher reports of high satisfaction, (86 percent) and that was for telehealth visits that did not result in a prescription for antibiotics.
And when telehealth patients are unhappy they weren’t prescribed an antibiotic, their dissatisfaction is aimed at the telehealth platform, not an individual doctor. This alleviates the pressure physicians feel to prescribe antibiotics unnecessarily only to please the patient.
As health care professionals, it is incumbent upon us to not only adhere to the standard of care but also to educate the public about the risks of overprescribing antibiotics — to the patients themselves and to the general public.
Health care systems that have a patient-facing, non-video virtual care program incorporated into their primary care offer are likely already doing their part for antibiotic stewardship. Those that don’t would be wise to consider adding it to their primary and urgent care strategy. In addition to myriad other benefits — increased patient access, improved provider efficiency, a boost to the bottom line — taking the pressure to prescribe antibiotics unnecessarily off their providers is a win for everyone.
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