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Pay to Play – Telehealth and Inappropriate Antibiotics

March 25, 2024

Written by Shannon Markus

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Using online telemedicine platforms, the authors found that it was appallingly easy to rapidly obtain inappropriate antibiotic prescriptions for symptoms of viral URIs by paying a nominal fee. This highlights the need for increased education and regulations around inappropriate prescribing of antibiotics to safeguard the public and uphold good medical practices.

Ask Pay and you shall receive!
Telehealth has played a crucial role in enhancing patient access to healthcare services and information in recent years, with some services promoting themselves as a convenient means to obtain medical advice and medications as an alternative to ED visits. However, some have emerged as hubs for indiscriminate administration of antibiotics and other medications without much oversight.

The authors in this article (who were actually experiencing symptoms of viral URIs), engaged with two asynchronous telehealth platforms, one of which emphasizes that prescriptions are available “in minutes” without the need to talk to a clinician. Per encounter, the platforms cost US$64.99 and US$39.99, respectively, and had 350,000 and 500,000 visits each in one month. In three encounters, the platforms collected superficial information regarding the infection. In all cases, antibiotics were nearly immediately offered. Patients had the option of selecting a medication from a list or allowing the clinician to decide. There were no or minimal disclosures of medication side effects, no option to forgo antibiotics, and no additional counseling or follow-up was provided after the prescriptions were sent. The authors didn’t take the prescribed antibiotics and fully recovered from their presumed viral URIs.

Through these platforms, patients often receive their preferred antibiotic without consideration of clinical appropriateness and safety. Considering the large number of monthly visits to these platforms, prescription-on-demand services may meaningfully contribute to antibiotic overprescribing nationwide. There may be utility for e-prescribing medications based on patient self-diagnosis in very specific scenarios (ex. recurrent symptomatic UTI in females, positive home COVID test with URI symptoms), but even so, patients are not qualified to determine the appropriate antimicrobial. Many aspects of medical decision-making are the responsibility of the prescriber and should not be delegated to patients, who may not possess the necessary information or education to make a fully informed treatment decision.

How will this change my practice?
While this study may not change your practice caring for patients face-to-face in the ED, it underscores the importance of patient education regarding appropriate antibiotic use as well as careful consideration by providers when prescribing antibiotics – be it in person, via virtual visits, or via asynchronous care platforms.

Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance. Clin Infect Dis. 2024 Feb 17;78(2):308-311. doi: 10.1093/cid/ciad472.

What are your thoughts?