Trends in remote GP consultations and the impact of remote consultations on antibiotic prescribing of antibiotics pre- and during COVID - an observational study

Date of Approval
Application Number
Lay Summary
In the UK, there has been an increase in the number of GP consultations that take place remotely (by telephone, online or video), rather than by face-to-face (at the surgery or at home) since 2018. The COVID-19 pandemic has further accelerated the use of remote consultations making it even more important to understand the impact this shift will have on care.

An increase in remote consultations might have advantages such as shorter waiting times and less time spent travelling to get to an appointment, but it is unclear whether the outcome of the GP consultation might be affected by whether a GP consultation is remote or face-to-face. There is also limited information about who is using remote consultations and there are concerns that an increase in remote consultations might create health inequalities.

Some studies have suggested that remote consultations might be more likely to lead to inappropriate antibiotic prescriptions, e.g. for viral infections where antibiotics are ineffective. In addition, the pandemic is believed to have accelerated antimicrobial resistance as the pandemic made antimicrobial stewardship more difficult. This study aims to provide novel information on the extent of the use of remote consultations, both before and during the pandemic, and how the consultation mode (remote vs. face-to-face) affects antibiotic prescribing respiratory illnesses and urinary tract infections – two of the most common causes of prescribing. The findings will contribute to the evidence base to help design primary care in the future.
Technical Summary
The aim of this project is to define and study the use of remote consultations in primary care in England from 2018 up to and throughout the COVID-19 affected period, and to assess the impact of remote consultation on antibiotic prescribing. We intend to use data from CPRD Aurum linked to the index of multiple deprivation (IMD) at the patient level and the Rural-Urban Classification (RUC) at the practice level.

We will classify the mode of each consultation as either remote or face-to-face. To describe trends in remote consultations we will calculate the proportion of remote consultations, and the rate of remote consultations per 1000 consultations and per 1000 registered patient days on a weekly basis. This will also be done broken down by age, sex, patient level IMD, and practice level RUC monthly.
We will describe what type of patients (age, sex etc) are using remote vs. face-to-face consultations before and during the pandemic and what they are using primary care for according to the consultation diagnosis codes.

We will use multivariable logistic regression to test the association between consultation mode and antibiotic prescribing. We will restrict this analysis to consultations with a diagnosis code of acute respiratory infections (ARIs) and/or urinary tract infections (UTIs). These are among the most common causes for antibiotics prescribing in primary care and were commonly dealt with through remote consultations even before the pandemic. Models will adjust for i) sex and age, ii) indicators of need for health care (number of long-term conditions, combination of conditions), and iii) indicators of social need.

We will estimate the effect of remote appointments on antibiotic prescribing before and during the pandemic separately.
Understanding remote GP consultation patterns and the impact of remote consultations on antibiotic prescribing will help inform how primary care should be structured post-COVID.
Health Outcomes to be Measured
Outcomes of interest will be derived from CPRD and include:
• Consultation mode (remote compared to face-to-face) over time
• Consultation mode by diagnosis code, sex, age, patient level index of multiple deprivation, and Rural-Urban Classification
• Consultations for ARIs and UTIs that resulted in antibiotics being prescribed

Emma Vestesson - Chief Investigator - The Health Foundation

Emma Vestesson - Corresponding Applicant - The Health Foundation

Alison Dias - Collaborator - NHS England

Caroline Fraser - Collaborator - The Health Foundation

Elizabeth Crellin - Collaborator - The Health Foundation

Geraldine Clarke - Collaborator - The Health Foundation

Xiaochen GE - Collaborator - NHS England

2011 Rural-Urban Classification at LSOA level;Patient Level Index of Multiple Deprivation