ABSTRACT
ABSTRACT
Objective:
The
quality of care and
safety for
Telemedicine-discharged
patients with suspected
respiratory infections are closely related to low rates of
prescriptions of unjustified and high-
risk medications. This
retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer
telemedicine encounters at a large center using multidrug stewardship
protocols.
Methods:
A quarterly
electronic survey utilizing
medical records of individual
physician care assessed various quality
indicators.
Physicians received ongoing adaptive
feedback based on personal
metrics, with
Telemedicine Center recommendations derived from the 2020
Infectious Diseases Society of
America guidelines. The study included all consecutive
adults with new respiratory symptoms in the last 14 days
who sought spontaneous
Telemedicine consultations between March 2020 and August 2021. This study analyzed
patients with suspected or confirmed COVID-19 and other
airway infections.
Results:
Of the 221,128 evaluated
patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other
diagnoses.
Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%)
patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the
emergency department for whom there was no further
treatment recommendation. The
antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based
prescriptions was 0.01%/0.005%.
Conclusion:
Guideline training and
Telemedicine consultation feedback may
lead to lower
antibiotic and antimicrobial
prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship
protocols may improve
guideline adherence and reinforce the
quality of care and
safety in
Telemedicine encounters.
