Implementing Telemedicine to Improve Appropriate Antibiotic Prescribing for Acute Respiratory Tract Infections

PROJECT SUMMARY
Inappropriate antibiotic use for the management of acute respiratory tract infections (ARTIs) in ambulatory care
is a major driver of antibiotic resistance and an urgent public health threat. Despite decades of research and
interventions to increase evidence-based care for ARTIs, limited progress has been made. Telehealth visits
(THVs) have the potential to improve ARTI management and antibiotic prescribing by addressing factors that
influence inappropriate care and by implementing an approach that optimizes outcomes across populations.
The shift to care via THVs necessitated during the peak of the COVID-19 pandemic has created a climate of
increased acceptability for telemedicine and an important opportunity to address this question. We propose to
leverage the current innovative landscape of expanded use of telehealth to test whether THV approaches for
ARTIs can address drivers of inappropriate care and improve management. We seek to conduct a rigorous
implementation study using a mixed methods approach to develop and evaluate a multisite intervention
designed to improve ARTI care. We will conduct the study in ambulatory healthcare settings from three diverse
healthcare systems with patients of a wide range of racial and ethnic backgrounds, those for whom English is
not their primary language, and those with disparities related to social determinants of health. Our study will
first construct a prediction tool using retrospective data for ARTI encounters (acute sinusitis, pharyngitis,
bronchitis, and viral upper respiratory tract infections) at the three sites. The prediction tool will be used to
identify candidates for ARTI management via THV who are at low risk for poor outcomes. We will incorporate
the tool into the workflow of ambulatory care to optimize appropriate triage to THVs. Second, we will use prior
research by our team and other published data to define factors identified as barriers and facilitators for
inappropriate prescribing for ARTIs. Using that background, materials will be developed to facilitate appropriate
management and to educate patients. Those materials will be created via co-production with providers and
community members. Patient materials will be translated in languages reflective of the patient populations
served and be culturally sensitive. We will next conduct open pilot testing at hospital-based clinics at each of
the three participating healthcare systems to refine the process and materials and get feedback from both
patients and providers for adaptation and improvement. Finally, we will implement the approach across six
sites – the sites where the three open pilots were conducted and three affiliated community practices. We will
study outcomes including antibiotic prescribing, need for follow-up visits and encounters, and patient and
provider satisfaction with the THV, the process, and the medical care. Based on our assessment of outcomes,
including feasibility and sustainability, final materials will be organized into a toolkit for other sites to implement.

Grant Number: 5R01HS028814-04
NIH Institute/Center: AHRQ
Principal Investigator: TAMAR BARLAM