The impact of virtual care on antibiotic prescribing practices for Urinary Tract Infections (UTIs): a propensity-score matched cohort study

Background Since the emergence of COVID-19, virtual alternatives to in-person care have become commonplace with many physicians providing both virtual and in-person visit options within their practice. However, the rapid implementation of virtual care raises questions regarding its quality compared to in-person care, including for prescribing appropriateness and adherence to clinical guidelines. We examined whether prescribing patterns differed between virtual and in-person physician visits for urinary tract infections (UTIs) in British Columbia, Canada, a clinical presentation for which there was thorough guidance available on first-line therapy. Methods We used administrative data from 2022 to examine the association of virtual care with antibiotic prescribing for UTIs, including the likelihood of an antibiotic prescription, the type of antibiotic dispensed (broad- vs. narrow-spectrum), and the duration of antibiotic dispensed. Our analysis used propensity score matching techniques paired with logistic and linear regression models. Findings: Compared to in-person visits, virtual visits for UTI were associated with significantly lower odds of antibiotic dispensing (OR = 0.889; 95% CI: 0.872–0.905), significantly higher odds of broad-spectrum antibiotic dispensing (OR = 1.057; 95% CI: 1.015–1.102), and no significant difference in the duration of nitrofurantoin treatment (estimate = 0.337 days; 95% CI: − 0.485 to 1.159). Interpretation: Virtual care was associated with slightly lower antibiotic dispensation rates and similar treatment durations, but was also associated with more dispensation of broader spectrum antibiotics prescription. This raises potential concerns regarding antibiotic resistance that merit confirmation in studies that can assess indication, other clinical areas, and other settings.