Reducing Unnecessary Antibiotic Treatment for Acute Bronchitis Using Virtual Primary Care

Objective: Reducing antibiotic overuse is a point of emphasis of the Centers for Disease Control and Prevention (CDC). Despite this, both telemedicine and traditional in-person medical care struggle to meet national guidelines. This study evaluates antibiotic prescribing practices at 98point6, a Seattle-based provider of virtual primary care. This paper reviews a novel combination of machine learning with a physician-led virtual platform and smartphone interface to exceed published benchmarks for the avoidance of antibiotics in the treatment of bronchitis.   Design: This retrospective cohort study looks at patients ages 18–64 who presented to 98point6 with “acute bronchitis/bronchiolitis” diagnosed between December 1, 2019 and November 30, 2020. Visits were categorized by whether systemic antibiotics were or were not given. Cases in which systemic antibiotics were given were categorized as “broad spectrum” or “narrow spectrum”. The results are presented as descriptive statistics with demographic information and compared to published reports of antibiotic use for the treatment of bronchitis.   Results: Of the 1,238 visits with a bronchitis/bronchiolitis diagnosis, 99 (8.0%) were treated with prescribed systemic antibiotics. The rate of antibiotic avoidance of 92.0% compares favorably with published benchmarks from the National Committee for Quality Assurance and is significantly lower than rates in previously published samples for telemedicine, primary care and urgent care.   Conclusion: Virtual primary care administered by 98point6 resulted in a high rate of adherence to the established standard for the treatment of bronchitis, greatly exceeding benchmarks and published results from both telemedicine and in-person medical practice.