Diagnosis and management of acute infections during telehealth consultations in Australian general practice: a qualitative study

Background The use of telehealth has increased dramatically since the start of the COVID-19 pandemic. Little is known about how general practitioners (GPs) manage acute infections during telehealth, and the potential impact on antimicrobial stewardship.

Aim To explore the experiences and perceptions of GP trainees’ and supervisors’ use of telehealth and how it influences management of acute infections.

Design & setting Australian GP registrars (trainees) and supervisors were recruited via email through their training organisations. Semi-structured interviews with 18 participants were conducted between July-August 2022.

Method Interviews were transcribed verbatim and analysed using a reflexive thematic approach.

Results We identified six overall themes. (1) Participants experienced impaired diagnostic capacity during telehealth consultations. (2) Attempts to improve diagnostic acuity included various methods, such as having patients self-examine. (3) The management of clinical uncertainty frequently entailed referring patients for in-person assessment, over-investigating, or over-treating. (4) Antibiotic prescribing decisions during telehealth were informed by less information than were in-person consults, with varying impact. (5) Participants believed that other GPs improperly prescribed antibiotics during telehealth. (6) Supervisors believed that registrars hadn’t developed the knowledge or skills to determine when conditions could be managed appropriately via telehealth.

Conclusions Telehealth has provided potential for reducing transmission of acute infections and increasing access to healthcare. However, the implications of GPs, especially less experienced GPs, making diagnoses with less certainty and consequently compromising antimicrobial stewardship, are a concern. Patient self-assessment tools are may improve outcomes of telehealth consultations for acute infections.