Research

Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis

Mina Bakhit, Emma Baillie, Natalia Krzyzaniak, Mieke van Driel, Justin Clark, Paul Glasziou and Christopher Del Mar
BJGP Open 2021; 5 (6): BJGPO.2021.0106. DOI: https://doi.org/10.3399/BJGPO.2021.0106

Article Figures & Data

Figures

Tables

  • Table 1. Risk of bias of included observational studies using ROBINS-I
    ReferenceBias owing to confoundingBias in selection of participants into the studyBias inclassification of interventionsBias owing todeviations from intended interventionsBias owing to missing dataBias inmeasurement of outcomesBias in selection of the reported resultsOverall risk of bias
    Uscher-Pines (US, 2016)27 SeriousModerateModerateSeriousNo available informationModerateNo available informationModerate
    Gordon (US, 2017)16 SeriousModerateModerateModerateNo available informationModerateNo available informationModerate
    Shi (US, 2018)25 ModerateSeriousModerateModerateNo available informationModerateNo available informationModerate
    Davis (US, 2019)15 SeriousModerateModerateSeriousNo available informationModerateNo available informationSerious
    Halpren-Ruder (US, 2019)17 SeriousSeriousModerateModerateNo available informationModerateNo available informationModerate
    Ray (US, 2019)24 ModerateSeriousModerateModerateNo available informationModerateNo available informationModerate
    Miller (US, 2020)19 SeriousModerateModerateSeriousNo available informationModerateNo available informationModerate
    Murray (US, 2020)20 SeriousSeriousModerateSeriousNo available informationModerateNo available informationSerious
    Penza (US, 2020 A)22 SeriousSeriousSeriousSeriousNo available informationModerateNo available informationSerious
    Penza (US, 2020 B)23 SeriousSeriousSeriousSeriousNo available informationModerateNo available informationSerious
    Stenehjem (US, 2020)26 SeriousSeriousModerateSeriousModerateModerateNo available informationModerate
    Norden (US, 2020)21 SeriousSeriousSeriousSeriousNo available informationModerateNo available informationSerious
  • Table 2. Diagnostic test performed
    Study IDDiagnostic tests requestedConditionTH group N (%)F2F group N (%)Reported P valuea
    RCT
    McKinstry (UK, 2002)18 Not specified blood testAll conditions8 (4%)10 (5%)Not reported
    Not specified urine test6 (3%)8 (4%)
    X-ray1 (0.6%)5 (3%)
    Cross-sectional studies
    Gordon (US, 2017)b 16 Not specified lab testsUTI85 (20.6%)1095 (88.4%) < 0.001*
    Pharyngitis45 (15.8%)627 (73.5%) < 0.001*
    Sinusitis185 (11%)1302 (25.7%) < 0.001*
    Bronchitis40 (10.1%)308 (25.8%) < 0.001*
    Not specified ImagingCough18 (11.4)111 (23.5) 0.001*
    Bronchitis34 (8.6%)212 (17.8%) < 0.001*
    UTI34 (8.2%)227 (18.3%) < 0.001*
    URI69 (8.1%)236 (9.3%)0.31
    Sinusitis90 (5.3%)497 (9.8%) < 0.001*
    Murray (US, 2020)c 20 Urinalysis/dip stickUTI8 (5%)140 (93%) < 0.0001*
    Urine culture11 (7%)31 (21%) < 0.001*
    Norden (US, 2020)d 21 Not specified lab testsPharyngitis0.1250.2070.55
    URI excluding pharyngitis0.0230.1290.096
    Otitis media0.2500.1070.60
    Ray (US, 2019)24 Strep testStreptococcal Pharyngitis7 (1%)10 878 (67%)Not reported
    Shi (US, 2018)25 Strep testStreptococcal Pharyngitis9 (4%)17 818 (68%)Not reported

    • *Bold and asterisked P values indicate statistical significance.

    • ↵a χ2 test.

    • ↵b Tests were conducted within 21 days of index visit for all conditions.

    • ↵c Tests were conducted at initial encounter.

    • ↵d Average numbers of labs ordered.

    • URI
      upper respiratory tract infections
      UTI
      urinary tract infections
      TH
      telehealth
      F2F
      face-to-face
  • Table 3. Follow-up characteristics by initial encounter type
    Study IDFollow-up visits withinConditionTH groupF2F
    Number of follow-up visits%Number of follow-up visits%
    Ray (US, 2019)24 2 daysARI226558751
    21 days5251145 6299
    Shi (US, 2018)25 2 daysARI1165347130.5
    21 days38841056 5576
    Gordon (US, 2017)16 21 daysAll conditions130228390028
    Murray (US, 2020)20 Same day as initial encounterUTI151069
    30 days47313926
    Penza (US, 2020 A)22 Same day as initial encounterSinusitis264915
    30 days53352114
    Penza (US, 2020 B)23 14 daysConjunctivitis9246157
    Norden (US, 2020)21 1 dayPharyngitisNot reported40Not reported21
    ARI72
    Otitis media137
    3 daysPharyngitisNot reported53Not reported28
    ARI149
    Otitis media1314
    • TH
      telehealth
      F2F
      face-to-face
      ARI
      acute respiratory infection

Supplementary Data

  • BJGPO.2021.0106.pdf -

    Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.
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BJGP Open
Vol. 5, Issue 6
January 2021
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Antibiotic prescribing for acute infections in synchronous telehealth consultations: a systematic review and meta-analysis
Mina Bakhit, Emma Baillie, Natalia Krzyzaniak, Mieke van Driel, Justin Clark, Paul Glasziou, Christopher Del Mar
BJGP Open 2021; 5 (6): BJGPO.2021.0106. DOI: 10.3399/BJGPO.2021.0106
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Intended for Healthcare Professionals
 
 

British Journal of General Practice