Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Real-Time, Text-Based Primary Care

Abstract

Objective

Reducing antibiotic overuse is a point of emphasis of the Centers for Disease Control and Prevention. Inappropriate use of antibiotics is cited as a key driver of antibiotic resistance. Despite this, both telemedicine and traditional in-person medical care struggle to meet national guidelines. This study evaluates antibiotic prescribing practices at 98point6, a Seattle-based provider of real-time, text-based primary care. This paper reviews a novel combination of machine learning with a physician-led virtual platform and smartphone interface to exceed published benchmarks for the avoidance of antibiotics in the treatment of bronchitis.

Design

This retrospective cohort study looks at patients ages 18–64 who were evaluated and treated using real-time, text-based care. Cases in which patients were diagnosed with “acute bronchitis/bronchiolitis” between December 1, 2019 and November 30, 2020 were analyzed. Visits were categorized by whether systemic antibiotics were or were not given.

Setting

This telemedicine provider provides service to patients ages 1 and above in all 50 states and the District of Columbia. The cohort that is present was drawn from that population.

Participants

A total of 1,238 consecutive patients ages 18–64 who presented for medical care during the time period.

Interventions

This is a retrospective cohort. No direct intervention was undertaken. Patients received standard care for the evaluation and treatment of upper respiratory symptoms.

Main Outcome Measures

The results are presented as descriptive statistics with demographic information and compared to published reports of appropriate antibiotic use for the treatment of bronchitis.

Results

Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% compares favorably with published benchmarks from the National Committee for Quality Assurance and is significantly lower than rates in previously published samples for telemedicine, primary care, and urgent care.

Conclusion

Real-time text-based care resulted in a high rate of adherence to the established standard for the treatment of bronchitis, greatly exceeding benchmarks and published results from both telemedicine and in-person medical practice.