Association between antibiotic receipt and provider rating within a national telemedicine practice

Included Health aims to enhance the quality of care by providing antibiotic stewardship training to clinicians, targeting the reduction of unnecessary antibiotic prescribing. This initiative is crucial in combating antibiotic resistance and mitigating associated harmful side effects. To assess the effectiveness of this training, we collaborated with renowned researchers at the Antibiotic Resistance Action Center at the Milken Institute School of Public Health at George Washington University and Children’s National Hospital. Our objective was to determine if the training leads to lower prescribing rates and a diminished impact of antibiotic prescription receipt on provider star ratings.

• Our practice exhibited significantly lower rates of antibiotic prescribing and higher overall provider ratings compared to previous studies of telehealth practices lacking antibiotic stewardship initiatives.
• Clinicians in our practice prescribed antibiotics 50–75% less frequently than telehealth providers in other published studies.
• Over 90% of patients rated their provider with 5 stars, regardless of whether they received an antibiotic prescription.

These findings indicate that telemedicine providers can uphold high provider ratings while adhering to antibiotic stewardship by offering supportive care, such as non-antibiotic prescriptions, and spending more time explaining treatment choices.

This retrospective cohort study investigates the association between prescription receipt and provider 5-star ratings for adult visits with upper respiratory infections (URIs) within a national telemedicine practice with active antibiotic stewardship initiatives. The study includes patients aged 18 or older diagnosed with URI or bronchitis between May 2021 and April 2022. Results indicate that the odds of receiving a 5-star rating were higher for visits where patients received either an antibiotic or non-antibiotic prescription, as well as for longer visit durations. This suggests that while antibiotic stewardship initiatives may reduce unnecessary antibiotic prescriptions, they do not negatively impact patient satisfaction.

The study analyzed 68,607 visits across 298 providers, focusing on visits that received a rating. Approximately 14.8% of visits included an antibiotic prescription, and 62.2% included a non-antibiotic prescription. Over 95% of visits received a 5-star rating. The analysis revealed that visits with an antibiotic prescription had higher odds of a 5-star rating (AOR 2.56) compared to those without any prescription. Non-antibiotic prescriptions also increased the odds of a 5-star rating (AOR 1.55). Additionally, longer visit durations were positively correlated with higher ratings (AOR 1.03 per additional minute).

These findings highlight the importance of effective communication and patient education in telemedicine. Providers who adhere to antibiotic stewardship protocols can still achieve high patient satisfaction by taking time to explain treatment decisions and offering supportive care options. This study underscores the potential for telemedicine to deliver quality care while combating antibiotic resistance through responsible prescribing practices.

Greeshmasree Kambam, Shiva Salehian, Cindy M Liu, Nina Kleinschmidt, Kristin Dean, Vibin Roy, Jaclyn Marshall, Rana F Hamdy, Association between Antibiotic Receipt and Provider Rating within a National Telemedicine Practice, Open Forum Infectious Diseases, 2024;, ofae310, https://doi.org/10.1093/ofid/ofae310

Affiliated authors:
Nina Kleinschmidt, PharmD BCPS, Kristin Dean, MD, Vibin Roy, MD, Jaclyn Marshall, MS, Rana F Hamdy, MD, Greeshmasree Kambam, MD, Shiva Salehian, MD, PhD, Cindy M Liu, MD, PhD, ARAC at George Washington University, Children’s National Hospital, Virginia Commonwealth University School of Medicine, George Washington University School of Medicine and Health Sciences