einstein (São Paulo). 24/Jun/2024;22:eAO0707.
Multidrug stewardship and adherence to guidelines in >200,000 direct-to-consumer Telemedicine encounters
DOI: 10.31744/einstein_journal/2024AO0707
Highlights
Up to 75% of COVID-19 telemedicine patients receive unnecessary drugs; this highlights the need for research.
This study assessed the effect of guideline training and feedback on 200,000 telemedicine visits in Brazil.
Under 2% of patients with COVID-19 received non-guideline recommended antimicrobials, reflecting high adherence rates.
Targeted interventions significantly enhance guideline compliance for safer telemedicine prescriptions.
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.
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