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Comment & Response
April 2019

Balance Between Best Practice and Patient Satisfaction: Antimicrobial Stewardship in Telemedicine

Author Affiliations
  • 1Doctor on Demand, San Francisco, California
  • 2Children’s National Health System, Washington, DC
  • 3Stanford University, Stanford, California
  • 4George Washington University School of Medicine & Health Sciences, Washington, DC
JAMA Intern Med. 2019;179(4):588-589. doi:10.1001/jamainternmed.2018.8744

To the Editor In a recent issue of JAMA Internal Medicine, Martinez and colleagues1 demonstrated an association between antibiotic prescribing for treatment of respiratory tract infections (RTIs) and patient satisfaction scores in direct-to-consumer (DTC) telemedicine. Based on a patient satisfaction rating scale of 0 to 5, the authors dichotomized their primary outcome of patient satisfaction as 5 stars vs fewer than 5 stars; they found that 91% of patients prescribed antibiotics for treatment of RTI provided a 5-star rating compared with 73% of patients not prescribed antibiotics and 86% of patients given a nonantibiotic prescription. The authors concluded that “Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time.”1(1559)

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