Background: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective: This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods: Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results: In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions: There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

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中文翻译：

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远程会诊对基层医疗机构中抗生素处方的影响：系统评价

背景：尤其是在当前的COVID-19大流行中，国际上对在初级保健中进行远程咨询的兴趣日益增长。尽管如此，围绕远程协商安全性的证据尚无定论。远程会诊中抗生素处方的适当性是患者安全的重要方面，需要解决。目的：本研究旨在总结有关远程处方对抗生素处方在初级保健中的影响的证据。方法：在MEDLINE，Embase，HMIC，PsycINFO和CINAHL中进行检索，检索自数据库建立至2020年2月以来发表的文献。包括在初级卫生保健机构进行的同行评审研究。考虑了所有远程咨询类型，并且需要进行研究以报告要纳入本系统评价的任何抗生素处方定量方法。如果没有比较组，则排除研究（面对面咨询）。结果：总共鉴定出12个研究。其中，有4项研究报告了较高的抗生素处方率，有5项研究报告了较低的抗生素处方率，还有3项研究报告了与面对面咨询相比，远程会诊中的抗生素处方率相似。鼻窦炎患者的远程和面对面咨询中，指南一致的处方无显着差异，但是对于急性呼吸道感染患者，发现的结果不一致。在远程和面对面的协商后，发现随访随访率的证据混合。结论：没有足够的证据自信地得出结论，远程咨询会对基层医疗中的抗生素处方产生重大影响。但是，有研究表明，远程会诊中的开处方率比面对面会诊更高。此外，需要进行良好的研究以告知安全和适当地实施远程咨询，以确保不会对抗菌素耐药性产生意外影响。

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