Telemedicine’s Role in Curbing Antibiotic Overuse

The rapid growth of telemedicine has brought both challenges and opportunities for improving antibiotic use and integrating antibiotic stewardship practices in outpatient telemedicine settings. This narrative review aims to inform the adaptation of the Core Elements of Outpatient Antibiotic Stewardship framework to telemedicine. The goal is to optimize antibiotic prescribing, ensuring patient safety and healthcare quality.  

Outpatient telemedicine refers to the use of technology and telecommunication systems to deliver healthcare to patients who are physically separated from their healthcare providers. This approach has gained significant traction, especially during the COVID-19 pandemic, and has the potential to transform healthcare delivery. However, it presents unique challenges when it comes to antibiotic stewardship.  

Antibiotic stewardship is the systematic effort to measure and improve antibiotic use, with the primary objective of ensuring that antibiotics are prescribed and used only when they offer clear benefits. In 2016, the Centers for Disease Control and Prevention (CDC) introduced the Core Elements of Outpatient Antibiotic Stewardship framework as a guide to enhancing antibiotic prescribing practices in outpatient healthcare settings. 

Outpatient settings account for over 80% of human antibiotic use, and research indicates that at least 28% of antibiotic use in this context is unnecessary. This overuse contributes to increased costs, adverse drug events, and the development of antibiotic resistance, a growing public health concern.  

The expansion of telemedicine presents an opportunity to address these challenges and improve antibiotic stewardship. However, it requires adapting traditional in-person stewardship interventions to the telemedicine environment.  

Observational studies have shown the benefits of telemedicine, such as high-quality care, patient convenience, cost-effectiveness, care continuity, and improved access, especially for underserved populations. While the benefits of outpatient antibiotic stewardship are well-documented, there is a scarcity of studies demonstrating how these interventions can be effectively applied in telemedicine settings. 

To bridge this gap, the article presents considerations for integrating the Core Elements of Outpatient Antibiotic Stewardship into telemedicine. This entails building upon the growing body of evidence related to care delivery and quality improvement in telemedicine. However, it also highlights the need for further research and implementation studies to guide the effective, sustainable, and equitable application of antibiotic stewardship interventions in outpatient telemedicine. 

There are several potential strategies to achieve this integration. Technology-driven quality improvement approaches could play a pivotal role in adapting antibiotic stewardship practices to telemedicine. Moreover, innovative interventions specifically designed for virtual platforms may need to be developed. 

It is essential to ensure that these stewardship interventions do not compromise patient satisfaction. Maintaining or even increasing patient satisfaction is crucial to gaining the support of clinicians and healthcare leadership. 

Another critical aspect is the optimization of telediagnoses to guarantee patient safety. The use of virtual technology for diagnosing and treating common infections should be considered when updating clinical practice guidelines, as this could help align telemedicine with antibiotic stewardship best practices. 

The expansion of outpatient telemedicine services in the United States represents a significant opportunity. It can enhance healthcare access, reduce costs, and improve antibiotic use across outpatient care settings. By scaling antibiotic stewardship best practices across various health systems and commercial direct-to-consumer telemedicine models, we can ensure high-quality and equitable healthcare delivery while preserving the effectiveness of antibiotics and safeguarding patient safety. 

The growth of telemedicine offers a unique chance to enhance antibiotic stewardship in outpatient settings, where antibiotic overuse is a pressing issue. Integrating the Core Elements of Outpatient Antibiotic Stewardship into telemedicine is essential to optimize antibiotic prescribing and improve patient outcomes. However, this integration requires careful consideration, research, and the development of innovative solutions tailored to the virtual healthcare environment. Ultimately, by doing so, we can improve healthcare quality, reduce costs, and address the global challenge of antibiotic resistance. 

Journal Reference  

Guillermo V. Sanchez et al, Antibiotic Stewardship in Outpatient Telemedicine: Adapting Centers for Disease Control and Prevention Core Elements to Optimize Antibiotic Use, Telemedicine and e-Health (2023). DOI: 10.1089/tmj.2023.0229