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Cited by 80Antibiotic Use and ResistanceTelemedicine and Telehealth ImplementationPrimary Care and Health Outcomes

Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

Open access
Han, Seung Min, Greenfield, Geva, Majeed, Azeem, Hayhoe, Benedict·2020·Journal of Medical Internet Research
DOI 10.2196/23482PMC PMC7655728

Published version of a preprint

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Abstract

Background: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective: This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods: Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results: In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions: There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review found mixed evidence on whether remote consultations in primary care change antibiotic prescribing compared with face-to-face consultations. Across 12 studies, 4 reported higher prescribing remotely, 5 lower, and 3 similar, with insufficient evidence to draw a confident conclusion.

Key findings

  • Of 12 included studies, 4 reported higher antibiotic-prescribing rates in remote consultations, 5 reported lower rates, and 3 reported similar rates compared with face-to-face consultations.
  • Examples of higher remote prescribing included sinusitis (99% vs 94%; P<.001) and urinary tract infection (99% vs 49%; P<.001) in Mehrotra et al, 2012, and acute respiratory infection (52% vs 31%; P<.001) in Ray et al, 2019.
  • Examples of lower remote prescribing included sinusitis (68.6% vs 94.3%; P<.001) in Johnson et al, 2019 and acute respiratory infection (52% vs 53%; P<.01) in Shi et al, 2018; McKinstry et al, 2002 found no significant difference (19.3% vs 16.0%; difference −3.3%, 95% CI −11.1% to 4.5%).
  • Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for sinusitis, but results were conflicting for acute respiratory infections; evidence on follow-up visit rates was mixed.

Methods

  • Systematic review following PRISMA, searching MEDLINE, Embase, HMIC, PsycINFO, and CINAHL from inception to February 14, 2020 for peer-reviewed primary studies in primary health care that compared remote consultations with face-to-face consultations and reported quantitative antibiotic prescribing.
  • Twelve studies were included: 9 from the United States, 2 from Denmark, and 1 from Norway; 11 were cohort studies and 1 was a randomized controlled trial.
  • Risk of bias was assessed with the National Heart, Lung, and Blood Institute tool for observational studies and the Cochrane tool for RCTs; results were synthesized narratively because studies were too heterogeneous for meta-analysis.

Limitations

  • The authors state that terminology variation may have led to omitted papers, relevant papers may exist in grey literature or non-English languages, included studies came from only 4 high-income countries, and setting differences such as retail clinics versus primary care practices and nurse practitioners versus physicians were unaccounted for.
  • The authors also note the dearth of relevant papers and that the small number of studies meant no clear pattern emerged regarding setting.
  • Evident from the text: only 1 included study was an RCT, most were observational, and heterogeneity in populations, consultation types, and outcome definitions precluded meta-analysis; only 2 studies provided sample size justifications or power calculations, and 4 lacked adjustment for any confounding factors.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/23482

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 93 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Of the 12 included studies, 5 reported lower antibiotic-prescribing rates in remote consultations compared with face-to-face consultations.

    “Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations.

    “Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis.

    “Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections.”
    Quote in the paperSubstantial claim
  • Findingown data

    The systematic review identified 12 studies.

    “In total, 12 studies were identified.”
    • Also stated in: § Study Selection · plain
      “Our electronic database search yielded 2427 results, of which 12 studies were included in this review (Figure 1) [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Findingown data

    Of the 12 included studies, 3 reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations.

    “Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Findingown data

    The quality of included studies was generally fair, with 7 moderate-quality studies, including the RCT, and 5 observational studies considered high quality.

    “The quality of studies was generally fair, with 7 moderate-quality studies, including the RCT, and 5 observational studies that were considered high quality.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingcitation

    Rokstad and Straand 1997 reported that antibiotic-prescribing rate was lower in remote consultations; 7.8% of remote prescriptions were antibiotics versus 17.8% of face-to-face prescriptions.

    “Intervention: 43.5% of all prescriptions; 7.8% of remote prescriptions were antibiotics Control: 56.6% of all prescriptions; 17.8% of face-to-face prescriptions were antibiotics”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Another study concluded that fewer antibiotics were avoided for bronchitis patients consulting over the phone; patients were more likely to receive an antibiotic for the same condition when consulting remotely.

    “Another study concluded that fewer antibiotics were avoided for bronchitis patients consulting over the phone; patients were more likely to receive an antibiotic for the same condition when consulting remotely [24].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Ewen et al 2015 reported that 12.4% of all antibiotics prescriptions were made through telephone.

    “12.4% of all antibiotics prescriptions made through telephone (6617 telephone consultations and 27,487 office consultations; 63,418 antibiotics were prescribed during 61,707 consultations to 31,302 individuals)*”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The RCT described adequate randomization but lacked blinding.

    “The RCT described adequate randomization, but lacked blinding [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] McKinstry, B, 2002, Br J Gen Pract

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Penza et al found higher antibiotic-prescribing rates for both telephone and text-based e-visits, but only the difference in telephone consultations was statistically significant.

    “Penza et al found this relationship for both telephone and text-based e-visits, but only the difference in telephone consultations was statistically significant [19].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    Two included studies could not be compared with the other included studies due to differences in outcome measures, and neither included a direct estimate of antibiotic prescribing.

    “It was difficult to compare 2 studies with the other included studies due to differences in outcome measures; neither included a direct estimate of antibiotic prescribing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Murray et al 2019 reported that for urinary tract infection, the antibiotic-prescribing rate from text-based e-visits was 81% in remote consultations versus 83% in face-to-face consultations (P=.65).

    “Intervention: 81%, control: 83% (P=.65)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Penza et al 2020 reported that for conjunctivitis, the antibiotic-prescribing rate from text-based e-visits was 25.7% in remote consultations versus 19.8% in face-to-face consultations (P=.24).

    “Intervention: 25.7%, control: 19.8% (P=.24)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations.

    “In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations [22,24,27].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22] source

      Not checked in the free run.

    • cites [24] source

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Mehrotra et al, PCPs were less likely to order a UTI-relevant test in face-to-face consultations (did not order: 8%, did order: 51%; P<.01) but more likely to prescribe an antibiotic for UTI in remote consultations.

    “Mehrotra et al [22] concluded that PCPs were less likely to order a UTI-relevant test in face-to-face consultations (did not order: 8%, did order: 51%; P<.01), but more likely to prescribe an antibiotic for UTI in remote consultations.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] source

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    All 4 guideline-concordant prescribing studies were from the United States and investigated populations with confirmed sinusitis, UTI, or acute respiratory infection.

    “All studies were from the United States and investigated populations with a confirmed diagnosis of sinusitis [22,26], UTI [22], or acute respiratory infection [25,27].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [22] source

      Not checked in the free run.

    • cites [26] source

      Not checked in the free run.

    • cites [25] source

      Not checked in the free run.

    • cites [27] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given

    To the authors' knowledge, this is the first systematic review to examine how antibiotic prescribing is affected by remote consultation in primary care.

    “To our knowledge, this is the first systematic review to examine how antibiotic prescribing is affected by remote consultation in primary care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Murray et al and Mehrotra et al found no significant difference in follow-up visit rates between consultation types within the following 3 weeks and 30 days after the initial consultation, respectively.

    “However, Murray et al [18] and Mehrotra et al [22] found no significant difference in follow-up visit rates between the consultation types within the following 3 weeks and 30 days after the initial consultation, respectively.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [18] source

      Not checked in the free run.

    • cites [22] source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Johnson et al found higher follow-up rates for text-based e-visits relating to sinusitis in the subsequent 24 hours and 30 days after the initial consultation, but no difference at 7 days.

    “Johnson et al [26] found this relationship to be true for text-based e-visits relating to sinusitis in the subsequent 24 hours and 30 days after the initial consultation, but found no difference in follow-up consultations at 7 days after the initial consultation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The review faced a dearth of relevant papers.

    “Other challenges we faced while conducting this review included the dearth of relevant papers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    There is significant variation in terminology among researchers, which could have led to the omission of a few relevant papers.

    “However, there is significant variation in terminology among researchers, and this could have led to the omission of a few relevant papers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The current literature is reliant on studies from high-income countries and observational studies, as confirmed by the inclusion of only one RCT in this review.

    “Moreover, the current literature is reliant on studies from high-income countries and observational studies, as confirmed by the inclusion of only one RCT in this review.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    In some studies, remote consultations were evaluated by nurse practitioners, who may have had a different skillset compared to primary care physicians who consulted with patients face-to-face.

    “Moreover, in some studies, remote consultations were evaluated by nurse practitioners, who may have had a different skillset compared to primary care physicians who consulted with patients face-to-face.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Remote consultations have been playing a substantial role in the health care response to the current COVID-19 pandemic by supporting continued access to services with minimized risk of disease transmission.

    “remote consultations have been playing a substantial role in the health care response to the current COVID-19 pandemic by supporting continued access to services with minimized risk of disease transmission [2,3].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] source

      Not checked in the free run.

    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Three reviewers independently screened studies for inclusion.

    “We had 3 reviewers independently screen studies for inclusion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    SH assessed the quality of all papers and BH and GG each assessed half of the studies independently.

    “SH assessed the quality of all papers and BH and GG each assessed half of the studies independently.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    Risk of bias was assessed using the National Heart, Lung, and Blood Institute tool for observational studies and the Cochrane risk of bias tool for RCTs.

    “The National Heart, Lung, and Blood Institute tool [13] was used to assess observational studies, and the Cochrane risk of bias tool [14] was applied to RCTs.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] National Heart, Lung, and Blood InstituteQuality Assessment Tool for Observational Cohort and Cross-Sectional StudiesStudy Quality Assessment Tools2020-10-21https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

      Not checked in the free run.

    • cites [14] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Over 90 countries were reported to be already delivering health care services over the telephone in 2016.

    “Over 90 countries have been reported to be already delivering health care services over the telephone in 2016 [1]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] World Health Organization,, 2016, Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review was conducted following PRISMA guidelines.

    “This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (Multimedia Appendix 1) [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The studies examining specific indications for antibiotics suggested that antibiotic-prescribing rates for patients with UTI in remote consultations was higher than in face-to-face consultations, but 1 study did not find any difference.

    “The studies examining specific indications for antibiotics suggested that antibiotic-prescribing rates for patients with UTI in remote consultations was higher than in face-to-face consultations, but 1 study did not find any difference [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    More recent reviews agree that there is a need for more research on the safety of care and the quality and safety of prescribing through remote consultations.

    “More recent reviews agree that there is a need for more research on the safety of care [4] and the quality and safety of prescribing through remote consultations [4,32].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source

      Not checked in the free run.

    • cites [32] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Similar guideline-concordant prescribing between remote and face-to-face consultations is reassuring, but the evidence for whether the management at remote consultations is effective is less clear.

    “Similar guideline-concordant prescribing between remote and face-to-face consultations is reassuring, but the evidence for whether the management at remote consultations is effective is less clear.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A systematic review of reviews on the benefits of telemedicine in 2002 found too little high-quality evidence to confidently conclude that telemedicine was beneficial.

    “A systematic review of reviews on the benefits of telemedicine in 2002 found too little high-quality evidence to confidently conclude that telemedicine was beneficial.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Compared to face-to-face consultations, PCPs order fewer tests and investigations and are unable to physically examine patients in remote settings, which can affect the appropriateness of patient management.

    “Compared to face-to-face consultations, PCPs order fewer tests and investigations and are unable to physically examine patients in remote settings, which can affect the appropriateness of patient management [8,28].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] source

      Not checked in the free run.

    • cites [28] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Clinicians consulting in retail clinics via private telemedicine providers could feel pressured to prescribe antibiotics due to patient expectations and diagnostic uncertainty from lack of continuity in commercial remote consultations.

    “Clinicians consulting in retail clinics via private telemedicine providers could feel pressured to prescribe antibiotics due to the expectations of patients who pay to see clinicians and the diagnostic uncertainty that stems from the lack of continuity in these commercial remote consultations [29].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The review attempted a comprehensive search by manually searching reference lists to find relevant search terms for remote consultation.

    “We tried to conduct a comprehensive search by manually searching reference lists to find relevant search terms for remote consultation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Antibiotic prescriptions made in follow-up appointments contribute to prescriptions made in face-to-face consultations, which could partially explain why some included studies found lower antibiotic-prescribing rates in initial remote consultations and higher frequencies of follow-up consultations.

    “As antibiotic prescriptions made in follow-up appointments contribute to prescriptions made in face-to-face consultations, this could provide a partial explanation for why some of the included studies found lower antibiotic-prescribing rates in initial remote consultations and higher frequencies of follow-up consultations [25,26].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] source

      Not checked in the free run.

    • cites [26] source

      Not checked in the free run.

    • Rests on an assumption: Antibiotic prescriptions made in follow-up appointments contribute to prescriptions made in face-to-face consultations.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    As this is a novel study, it is difficult to compare the findings of this review directly with other reviews.

    “As this is a novel study, it is difficult to compare the findings of this review directly with other reviews.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    A high follow-up visit rate does not necessarily correlate with poor management at initial consultation, but it raises the question of the effectiveness (including cost-effectiveness) of remote consultations.

    “Therefore, a high follow-up visit rate does not necessarily correlate with poor management at initial consultation, but it does raise the question of the effectiveness (including cost-effectiveness) of remote consultations.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Follow-up visits after remote consultations are often necessary per clinicians' advice and patients' need for physical examinations.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2002 systematic review reported that research was beginning to address the literature gaps in the field.

    “However, the review reported that research was beginning to address the literature gaps in the field [31].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

    Interpretationreasoning

    The divided weight of evidence in this review makes it difficult to inform health policy, as the evidence regarding remote consultations is still evolving.

    “The divided weight of evidence in this review makes it difficult to inform health policy, as the evidence regarding remote consultations is still evolving.”
    Quote in the paperNot a substantial claim
37 of 37

  • The paper relies on this without support.

    Overprescribing of antibiotics drives antimicrobial resistance, which is a global concern with consequent impact on patients and health systems, especially primary health care.

    “The overprescribing of antibiotics drives antimicrobial resistance, which is a global concern with consequent impact on patients and health systems, especially primary health care.”

  • The paper relies on this without support.

    Follow-up visits after remote consultations are often necessary per clinicians' advice and patients' need for physical examinations.

    “Follow-up visits after remote consultations are often necessary per clinicians’ advice and patients’ need for physical examinations.”

  • The paper relies on this without support.

    Retail clinics differ from primary care practices in that there is less chance of establishing a long-term doctor-patient relationship.

    “For example, retail clinics differ from primary care practices, as there is less chance of establishing a long-term doctor-patient relationship.”

  • The paper relies on this without support.

    Antibiotic prescriptions made in follow-up appointments contribute to prescriptions made in face-to-face consultations.

    “As antibiotic prescriptions made in follow-up appointments contribute to prescriptions made in face-to-face consultations”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • No significant differences were found in dosage and choice of antibiotics when comparing remote and face-to-face environments.

    “Han et al. (2020) [12], when comparing the dosage and choice of antibiotics, found no significant differences.”

    From Patient safety risk associated with synchronous telehealth: A scoping review (2025) · cites this paper as [12]

    The Results sections on prescribing behavior and guideline-concordant prescribing (page unavailable) compare prescribing rates and overall guideline concordance, not antibiotic dosage or choice. Searches for dosage, dosing, and antibiotic selection found no comparison of those outcomes between remote and face-to-face consultations. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Other studies have described problems of increased antimicrobial prescribing, reduced ordering of diagnostic investigations and delayed diagnosis of cancer attributed to the pandemic-related shift to remote consultations.

    “Other studies have described problems of increased antimicrobial prescribing (120), reduced ordering of diagnostic investigations (121) and delayed diagnosis of cancer (122, 123) attributed to the pandemic-related shift to remote consultations”

    From Planning and Evaluating Remote Consultation Services: A New Conceptual Framework Incorporating Complexity and Practical Ethics (2021) · cites this paper as [120]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Huibers study is classified as lower prescribing despite a higher remote rate

    Major

    The Huibers results show an antibiotic-prescribing rate of 26.1% in remote consultations versus 10.7% face-to-face, yet the study is listed and discussed among those with lower prescribing in remote consultations. This affects the review's count of studies favoring each direction.

  • Country totals leave out the Scottish study

    Minor

    The stated country counts account for all 12 studies as being in the United States, Denmark, or Norway, but Table 1 identifies McKinstry et al as a study conducted in Scotland.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. World Health Organization,, 2016, Global diffusion of eHealth: making universal health coverage achievable: report of the third global survey on eHealth
  2. McKinstry, B, 2002, Br J Gen Pract, 52, 306

Cited by

Sorted by citations

Authors
Han, S. M., Greenfield, G., Majeed, A., & Hayhoe, B.
Affiliations
Imperial College London (GB)
Corresponding author
Greenfield, Geva
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2020-11-09
Volume
22
Issue
11
Pages
e23482
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/23482
PMC
PMC7655728
OpenAlex
W3090542392
Semantic Scholar
6ebf4508ead332794e8d60dc6f03ec8dbfa473e5
Cited by
80
References
29
Citations by year
2026: 7 · 2025: 6 · 2024: 13 · 2023: 17 · 2022: 14 · 2021: 23
FWCI
1.99
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Spiral (Imperial College London) (submittedVersion, cc-by)
Funders
National Institute for Health and Care Research (CL-2015-21-008)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
teleconsultation, telemedicine, antibiotic prescribing, primary care, face-to-face consultation, guideline-concordant prescribing, sinusitis, acute respiratory infections, follow-up visits, antimicrobial resistance, COVID-19 pandemic
MeSH terms
SARS-CoV-2, COVID-19 Drug Treatment, Adult, Anti-Bacterial Agents, Female, Humans, Male, Primary Health Care, Remote Consultation

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