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.
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
Kaat De Corte - Collaborator - The Health Foundation
Xiaochen GE - Collaborator - NHS England
2011 Rural-Urban Classification at LSOA level;Patient Level Index of Multiple Deprivation