Impact of telehealth appointments on pharmaceutical management of dermatological conditions

ABSTRACT

The impact of the COVID-19 pandemic caused dermatology providers to use telemedicine to safely arrange clinic appointments during lockdowns. This study aimed to evaluate the impact of telehealth on antibiotic prescription length. Specifically, we sought to compare antibiotic length prescription for virtual vs. in-person visits before, during, and after COVID-19 shutdowns. A retrospective cohort study was performed using all documented pharmaceutical prescriptions of tetracycline in 2019-2021 prescribed by dermatology providers at a large academic tertiary referral center. Results show an increase in telemedicine visits from 0.75% (2019) to 18.51% (2020), with a decrease to 3.98% in 2021 (p<0.0001). Analysis demonstrates that a tetracycline prescription of over 91 days was given in 37.90% vs. 28.83% of visits for virtual vs. in-person visits respectively (p<0.0001). Interestingly, 52.64% of antibiotic prescriptions written by staff physician dermatologists exceeded 91 days vs. 18.18% for dermatology fellows, 25.74% for resident physicians, and 21.35% for physician-assistants (p<0.001). The demonstrated increase in duration of tetracycline prescription during virtual visits is perhaps indicative of less data available for clinical decision-making, longer wait times between provider appointments during this era of lockdowns, and providers desire to make the visit worthwhile. Future studies should explore factors related to provider decision-making in virtual compared to in-person visits. This research is important in laying a foundation for how virtual visits may play a greater role in dermatologic care as we move towards a post-COVID world.