Remote consultations by general practitioners (GPs) have been increasing in number, a process which accelerated during the COVID-19 pandemic due to the need to reduce person-to-person virus transmission. Post-pandemic, they are especially useful when face-to-face presents risks or difficulties, such as in the case of immune-compromised patients. However, there is a need for more research to assess how this transition impacted the delivery of health services.
One of the concerned areas is antimicrobial prescribing. With the developing antimicrobial resistance crisis where resistance of microbes to drugs outpaces the discovery of antibiotics, there were increasing efforts to promote more responsible prescription and consumption of antibiotics. The study focuses specifically on prescriptions for urinary tract infections in primary care, and what are the key differences of antimicrobial prescribing for remote versus in-person consultations. Secondly, it will be investigated if they result in unintended outcomes, such as infection recurrence, accident and emergency department visit, out-patient visits, hospitalisation, or death. This is achieved using historical data in England between 2019 and 2023. Patient circumstances, such as age, sex, deprivation level, urbanicity, infection type or co-occurring health problems are accounted for to allow a non-biased comparison of the groups.
The findings will show if remote consultations in primary care impact prescribing patterns and the efforts to combat antimicrobial resistance versus in-person visits. Additionally, it will also allow practitioners and public authorities to have empirical knowledge for recommendations about the suitability of remote consultations and how their delivery can be improved taking into account personal circumstances.
A recent study found that remote consultations for acute respiratory infections (ARI) were 23% more likely to result in antibiotic prescription in adults, which impacts the UK ambition to reduce community antibiotic prescribing by 25% against a 2013 baseline. We propose to investigate the antibiotic prescribing patterns for remote versus face-to-face consultations in primary care for urinary tract infections (UTI) to assess how remote delivery impacts prescribing patterns for UTI, and, secondly, to assess its impact on the likelihood of hospital admissions (Hospital Episode Statistics (HES) Admitted Patient Care), out-patient visits (HES Outpatient), accident and emergency (A&E) admission (HES Accident and Emergency), or death (ONS Death Registration Data).
The use of five years’ worth of national general practitioners (GP) practice data in England will reflect fluctuations in infection burden, antibiotic prescribing, delivery mode and antimicrobial stewardship (AMS) during 2019-2023. Simultaneously, patient information, such as age, sex, comorbidities (e.g., diabetes), UTI type (lower/upper), as well as deprivation level (Patient Level Index of Multiple Deprivation) and urbanicity (2011 Rural-Urban Classification at LSOA level) will be predictors of outcome. The outcomes are the likelihood of a UTI consultation, whether remote or face-to-face, to follow with: antibiotic prescription, recurrent UTI, out-patient visit, hospital admission, A&E visit, or death episode. The main statistical method is mixed effects logistic regression modelling.
This research will provide an understanding of the impact and implications of mode of consultation on antibiotic prescribing and health complications for patients, allowing to further improve the delivery of health services. It may inform on the appropriateness of prescribing, which is essential for future policies in promoting AMS and combating the antimicrobial resistance crisis. Additionally, as antibiotics are frequently associated with side effects, reducing the factors in remote consultations that predispose to unnecessary prescribing will allow for an increase in patient quality of life.
- Monthly proportion of remote and face-to-face consultations for UTI that resulted in an antibiotic prescription (numerator) relative to the total number of remote and face-to-face consultations for UTI (denominator).
- Probability of an antibiotic prescription where a remote or face-to-face consultation is a binary co-variate
- Probability of a recurrent UTI where a remote or face-to-face consultation and an antibiotic prescription are binary exposures
- Probability of a hospital admission after three months following a consultation for UTI where a remote or face-to-face consultation and an antibiotic prescription are binary exposures
- Probability of an out-patient visit after three months following a consultation for UTI where a remote or face-to-face consultation and an antibiotic prescription are binary exposures
- Probability of a visit at an A&E department after three months following a consultation for UTI where a remote or face-to-face consultation and an antibiotic prescription are binary exposures
- Probability of a death episode after six months following a consultation for UTI where a remote or face-to-face consultation and an antibiotic prescription are binary exposures
Igor Pantea - Chief Investigator - UK Health Security Agency (UKHSA)
Igor Pantea - Corresponding Applicant - UK Health Security Agency (UKHSA)
Alicia Demirjian - Collaborator - UK Health Security Agency (UKHSA)
Angela Falola - Collaborator - UK Health Security Agency (UKHSA)
Diane Ashiru-Oredope - Collaborator - UK Health Security Agency (UKHSA)
Donna Lecky - Collaborator - UK Health Security Agency (UKHSA)
Hanna Squire - Collaborator - UK Health Security Agency (UKHSA)
Mehdi Minaji - Collaborator - UK Health Security Agency (UKHSA)
Sabine Bou-Antoun - Collaborator - UK Health Security Agency (UKHSA)
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification