背景:\“直接对消费者(DTC)远程医疗\”正在全球范围内增加,并改变了初级卫生保健(PHC)的地图。虚拟医疗在过去十年中有所增加,随着COVID-19大流行的持续,患者对在线护理的使用进一步增加。在瑞典,在线咨询是今天政府支持的医疗保健的一部分,瑞典市场上有几家数字护理提供商,这样就可以在几分钟内与医生取得联系。这个市场的快速扩张引发了人们对仅在没有任何身体预约的在线环境中提供的初级保健质量的质疑。抗生素处方是PHC的常见治疗方法。
目的:本研究旨在比较数字PHC提供者(互联网PHC)和传统物理PHC提供者(物理PHC)之间的抗生素处方,并确定特定诊断的处方在互联网PHC和物理PHC预约之间是否有所不同,根据任命时年龄的影响进行了调整,性别,和时间相对于COVID-19大流行。
方法:从2020年1月至2021年3月,从地区行政办公室获得了Sörmland地区居民基于解剖治疗化学(ATC)代码的抗生素处方数据。总的来说,包括68,332名Sörmland居民的160,238个任命(124,398个物理PHC和35,840个互联网PHC任命)。考虑了由互联网PHC或物理PHC医生发布的处方。关于预约日期的信息,为病人服务的人员类别,ICD-10(国际疾病统计分类,第十次修订)诊断代码,处方药的ATC代码,并使用患者的年龄和性别。
结果:总共登记了160,238次医疗保健预约,其中18433导致感染诊断。在物理PHC和互联网PHC约会中,性别和达到的年龄分布存在很大差异。物理-PHC预约在60-80岁的患者中达到顶峰,而互联网-PHC预约在20-30岁的患者中达到顶峰。在9.3%(11,609/124,398)的物理PHC预约中使用了ATC代码为J01A-J01X的抗生素,而在互联网PHC预约中使用了6.1%(2201/35,840)。此外,61.3%(6412/10454)的物理-PHC感染预约导致抗生素处方,相比之下,只有25.8%(2057/7979)的互联网PHC预约。对处方抗生素的分析表明,互联网PHC对所有诊断均遵循区域建议。Physical-PHC也遵循了建议,但使用了更广泛的抗生素。接受抗生素处方的赔率比(在预约时调整年龄后,患者性别,与物理PHC预约相比,在互联网PHC预约期间处方是否在COVID-19大流行之前或期间)为0.23-0.39。
结论:互联网-PHC预约导致抗生素处方数量明显低于物理-PHC预约,调整了咨询互联网PHC和物理PHC的患者特征的巨大差异。互联网PHC处方者根据指南显示适当的处方。
BACKGROUND: \"Direct-to-consumer (DTC) telemedicine\" is increasing worldwide and changing the map of primary health care (PHC). Virtual care has increased in the last decade and with the ongoing COVID-19 pandemic, patients\' use of online care has increased even further. In Sweden, online consultations are a part of government-supported health care today, and there are several digital care providers on the Swedish market, which makes it possible to get in touch with a doctor within a few minutes. The fast expansion of this market has raised questions about the quality of primary care provided only in an online setting without any physical appointments. Antibiotic prescribing is a common treatment in PHC.
OBJECTIVE: This study aimed to compare antibiotic prescribing between digital PHC providers (internet-PHC) and traditional physical PHC providers (physical-PHC) and to determine whether prescriptions for specific diagnoses differed between internet-PHC and physical-PHC appointments, adjusted for the effects of attained age at the time of appointment, gender, and time relative to the COVID-19 pandemic.
METHODS: Antibiotic prescribing data based on Anatomical Therapeutic Chemical (ATC) codes were obtained for Region Sörmland residents from January 2020 until March 2021 from the Regional Administrative Office. In total, 160,238 appointments for 68,332 Sörmland residents were included (124,398 physical-PHC and 35,840 internet-PHC appointments). Prescriptions issued by internet-PHC or physical-PHC physicians were considered. Information on the appointment date, staff category serving the patient, ICD-10 (International Statistical Classification of Diseases, Tenth Revision) diagnosis codes, ATC codes of prescribed medicines, and patient-attained age and gender were used.
RESULTS: A total of 160,238 health care appointments were registered, of which 18,433 led to an infection diagnosis. There were large differences in gender and attained age distributions among physical-PHC and internet-PHC appointments. Physical-PHC appointments peaked among patients aged 60-80 years while internet-PHC appointments peaked at 20-30 years of age for both genders. Antibiotics with the ATC codes J01A-J01X were prescribed in 9.3% (11,609/124,398) of physical-PHC appointments as compared with 6.1% (2201/35,840) of internet-PHC appointments. In addition, 61.3% (6412/10,454) of physical-PHC infection appointments resulted in antibiotic prescriptions, as compared with only 25.8% (2057/7979) of internet-PHC appointments. Analyses of the prescribed antibiotics showed that internet-PHC followed regional recommendations for all diagnoses. Physical-PHC also followed the recommendations but used a wider spectrum of antibiotics. The odds ratio of receiving an antibiotic prescription (after adjustments for attained age at the time of appointment, patient gender, and whether the prescription was issued before or during the COVID-19 pandemic) during an internet-PHC appointment was 0.23-0.39 as compared with a physical-PHC appointment.
CONCLUSIONS: Internet-PHC appointments resulted in a significantly lower number of antibiotics prescriptions than physical-PHC appointments, adjusted for the large differences in the characteristics of patients who consult internet-PHC and physical-PHC. Internet-PHC prescribers showed appropriate prescribing according to guidelines.