Research

Remote versus in-person consultations for acute cystitis: antibiotic treatment and clinical outcomes, a retrospective cohort study

Lars Emil Aga Haugom, Knut Erik Emberland, Ingrid Keilegavlen Rebnord, Guri Rørtveit and Knut Eirik Ringheim Eliassen
BJGP Open 2025; 9 (3): BJGPO.2025.0009. DOI: https://doi.org/10.3399/BJGPO.2025.0009

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Tables

  • Table 1. ICPC-diagnostic codes used to define pregnancy
    Codes indicating pregnancy if registered within 6 months preceding the index cystitis consultationICPC-2 codes
    Antepartum bleedingW03
    Pregnancy vomiting/nauseaW05
    Concern body image in pregnancyW21
    Limited function/disabilityW28
    Pregnancy symptom/complaintW29
    Infection complicating pregnancyW71
    Malignant neoplasm related to pregnancyW72
    Benign/unspecified neoplasm/pregnancyW73
    Injury complicating pregnancyW75
    Congenital anomaly complicating pregnancyW76
    PregnancyW78
    Unwanted pregnancyW79
    Toxaemia of pregnancyW81
    Pregnancy high riskW84
    Gestational diabetesW85
    With the simultaneous absence of the following codes:
    Abortion spontaneousW82
    Abortion inducedW83
  • Table 2. Acute cystitis contacts (index consultations and first repeat contacts <14 days), women aged ≥16 years in Norwegian primary care, 2018–2021
    YearsInhabitants in norwayNumber of cystitis contactsU71 contacts in total per 1000 femalesIn-person
    consultations per 1000 females    		Remote consultations per 1000 femalesSimple contacts** per 1000 females
    20182 139 995177 49882.973.90.48.6
    20192 157 623186 61486.576.60.99
    20202 177 584181 39883.364.7108.6
    20212 192 842177 7248161.112.27.7
    Annual average before COVID-19 (2018–2019)182 05684.775.20.68.8
    Annual average during COVID- 19 (2020– 2021)179 56182.262.911.18.2
    Index consultations for acute cystitis resulting in antibiotic treatment within three days per 1000 inhabitants, women aged ≥16 and up years in Norwegian primary care, 2018–2021
    Years Inhabitants in Norway Number of index cystitis consultations resulting in antibiotics All acute index cystitis consultations resulting in antibiotics per 1000 females In-person consultations resulting in antibiotics per 1000 females Remote consultations resulting in antibiotics per 1000 females
    20182 13 995115 4535453.70.2
    20192 157 623121 52656.355.90.4
    20202 177 584117 5165447.56.4
    20212 192 842115 21352.544.67.9
    Annual average before COVID-19 (2018–2019)118 49055.154.80.3
    Annual average during COVID- 19 (2020–2021)116 36553.346.17.2
    Repeat contacts for acute cystitis resulting in antibiotic treatment within three days per 1000 inhabitants, women aged ≥16 and up in Norwegian primary care, 2018–2021
    Years Inhabitants in Norway Number of repeat cystitis consultations resulting in antibiotics All acute repeat cystitis consultations resulting in antibiotics per 1000 females In-person consultations resulting in antibiotics per 1000 females Remote consultations resulting in antibiotics per 1000 females Simple contacts resulting in antibiotics per 1000 females
    20182 13 99527 903135.90.17.1
    20192 157 62329 89813.96.20.27.5
    20202 177 58430 29013.95.31.67.1
    20212 192 84228 540134.81.96.3
    Annual average before COVID-19 (2018–2019)28 90113.46.10.17.3
    Annual average during COVID- 19 (2020– 2021)29 41513.551.76.7

    • *Limited to females aged ≥16 years. **Limited to repeat simple contacts, included if occurring <14 days following an index consultation.

  • Table 3. Index in-person versus index remote consultations for acute cystitis, Norwegian primary care, 2018–2021. Distribution of consultations by patient age groups, year of consultation, pregnancy, multimorbidity status, antibiotic treatment <3 days, and repeat contacts <14 days
    In-person consultationRemote consultationTotalχ2 test, P value
    n 544 452 (92.9%)41 919 (7.1%)586 371 (100.0%)
    Age groups, years
    16-2577 706 (14.3%)4531 (10.8%)82 237 (14.0%)<0.001
    26-3570 625 (13.0%)6532 (15.6%)77 157 (13.2%)
    36-4558 752 (10.8%)5300 (12.6%)64 052 (10.9%)
    46-5568 024 (12.5%)6188 (14.8%)74 212 (12.7%)
    56-6574 158 (13.6%)5973 (14.2%)80 131 (13.7%)
    66-7594 846 (17.4%)6256 (14.9%)101 102 (17.2%)
    76-8572 064 (13.2%)4898 (11.7%)76 962 (13.1%)
    86-9526 745 (4.9%)2098 (5.0%)28 843 (4.9%)
    ≥961532 (0.3%)143 (0.3%)1675 (0.3%)
    Year
    2018144 064 (26.5%)744 (1.8%)144 808 (24.7%)<0.001
    2019150 296 (27.6%)1429 (3.4%)151 725 (25.9%)
    2020128 016 (23.5%)17 803 (42.5%)145 819 (24.9%)
    2021122 076 (22.4%)21 943 (52.3%)144 019 (24.6%)
    Pregnancy registered within the calendar year of the index consultation
    Not pregnant523 342 (96.1%)39 545 (94.3%)562 887 (96.0%)<0.001
    Pregnant21 110 (3.9%)2374 (5.7%)23 484 (4.0%)
    Multimorbidity registered within the calendar year of the index consultation
    No other morbidities469 432 (86.2%)34 838 (83.1%)504 270 (86.0%)<0.001
    Other morbidity75 020 (13.8%)7081 (16.9%)82 101 (14.0%)
    Recurrent cystitis in the calendar year of the acute cystitis episode
    <3 cystitis episodes per year511 394 (93.9%)38 745 (92.4%)550 139 (93.8%)<0.001
    >3 cystitis episodes per year33 058 (6.1%)3174 (7.6%)36 232 (6.2%)
    Antibiotics or not dispensed <3 days following index consultation
    No antibiotic treatment114 845 (21.1%)9750 (23.3%)124 595 (21.2%)<0.001
    Antibiotic treatment429 607 (78.9%)32 169 (76.7%)461 776 (78.8%)
    Types of antibiotics dispensed <3 days following index consultation
    First-line299 961 (69.8%)21 987 (68.3%)321 948 (69.7%)<0.001
    Second-line129 646 (30.2%)10 182 (31.7%)139 828 (30.3%)
    Repeat contact <14 days following index-consultation
    No repeat contact418 374 (76.8%)31 134 (74.3%)449 508 (76.7%)<0.001
    Repeat contact126 078 (23.2%)10 785 (25.7%)136 863 (23.3%)
    Type of repeat contact <14 days following index-consultation
    In-person consultation51 232 (40.6%)2655 (24.6%)53 887 (39.4%)<0.001
    Remote consultation6273 (5.0%)3133 (29.0%)9 406 (6.9%)
    Simple contact68 573 (54.4%)4997 (46.3%)73 570 (53.8%)
    Antibiotics or not dispensed <3 days following repeat contact
    No antibiotic treatment71 693 (56.9%)5959 (55.3%)77 652 (56.7%)<0.001
    Antibiotic treatment54 385 (43.1%)4826 (44.7%)59 211 (43.3%)
    If antibiotic treatment <3 days following index consultation and <3 days following repeat contact, antibiotic switch?
    Same antibiotic repeated33 284 (26.4%)3910 (36.3%)37 194 (27.2%)<0.001
    Different antibiotic92 794 (73.6%)6875 (63.7%)99 669 (72.8%)
    Pyelonephritis contact <14 days following index consultation
    Not pyelonephritis123 823 (98.2%)10 679 (99.0%)134 502 (98.3%)<0.001
    Pyelonephritis2255 (1.8%)106 (1.0%)2 361 (1.7%)
  • Table 4. Association between type of index consultation for acute cystitis and antibiotic treatment (within 3 days) and repeat contacts (within 14 days), 2018–2021, Norwegian primary care. Binomial regression.
    UnadjustedRisk ratio95% CIP value (α = 0.05)
    1. Antibiotic treatment (any) within 3 days
    In-person consultation1
    Remote consultation0.970.97 to 0.98<0.001
    2. Second-line antibiotic treatment within 3 days
    In-person consultation1
    Remote consultation1.051.03 to 1.07<0.001
    3. Repeat cystitis contact within 14 days
    In-person consultation1
    Remote consultation1.111.09 to 1.13<0.001
    4. Repeat contact for pyelonephritis within 14 days
    In-person consultation1
    Remote consultation0.550.45 to 0.67<0.001
    Adjusted* for: Outcomes and type of index consultation Risk ratio 95% CI P value (α = 0.05)
    Patient age, period, pregnancy, morbidity, and history of recurrent cystitis 1. Antibiotic treatment (any) within 3 days
    In-person consultation1
    Remote consultation0.980.97 to 0.98<0.001
    Patient age, morbidity, and history of recurrent cystitis 2. Second-line antibiotic treatment within 3 days
    In-person consultation1
    Remote consultation1.041.02 to 1.06<0.001
    Patient age, period, pregnancy, morbidity, history of recurrent cystitis and index antibiotic treatment 3. Repeat cystitis contact within 14 days
    In-person consultation1
    Remote consultation1.111.09 to 1.12<0.001
    Patient age, pregnancy, morbidity, history of recurrent cystitis and index antibiotic treatment 4. Repeat contact for pyelonephritis within 14 days
    In-person consultation1
    Remote consultation0.570.47 to 0.70<0.001

    • *Adjustments included were judged by the authors to be clinically relevant and met the cutoff point of P<0.10 by univariate analyses (χ2 test).

Supplementary Data

  • LEH_10.3399BJGPO.2025.0009_supp.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. 9, Issue 3
October 2025
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Remote versus in-person consultations for acute cystitis: antibiotic treatment and clinical outcomes, a retrospective cohort study
Lars Emil Aga Haugom, Knut Erik Emberland, Ingrid Keilegavlen Rebnord, Guri Rørtveit, Knut Eirik Ringheim Eliassen
BJGP Open 2025; 9 (3): BJGPO.2025.0009. DOI: 10.3399/BJGPO.2025.0009
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British Journal of General Practice