Does Telemedicine technology affect prescribing quality in primary care? The case of antibiotics

Modern health care systems face increasing challenges such as ageing populations, workforce shortages, and rising costs, prompting interest in new ways of delivering primary care services more efficiently. Telemedicine, which allows consultations to occur via phone rather than in person, is one such approach. While it offers clear benefits in terms of convenience and access, it also raises questions about clinical safety and decision-making when GPs are not able to conduct a physical examination, as certain perceptual and diagnostic cues may be lost in the absence of in-person assessment.

Before COVID-19, these concerns contributed to a cautious approach to telemedicine in primary care, but the pandemic led to its rapid and widespread adoption. As a result, telemedicine is now embedded in routine primary care delivery. However, the evidence base remains scarce, and the impact on service quality in this critical context is insufficiently understood.

Australia is a prime example of rapid telemedicine uptake in primary care: when the pandemic struck, policy change was implemented almost overnight so that remote consultations became widely available under universal health insurance, Medicare. Between March and September 2020 GPs provided around 25 million remote consultations, that is 25% of all GP visits. While utilisation has since levelled off from its peak, telemedicine still accounts for approximately one-in-seven primary care visits, underscoring the need to evaluate how this shift has affected the quality, safety and outcomes of care.

Our study fills part of this gap by assessing the impact of telemedicine on the behaviour of GPs. Specifically, we assess at the rate of antibiotics prescribing – a crucial and life-saving medication, that, however, has a high potential for being overprescribed, posing a serious threat to public health through accelerating the development of antimicrobial resistance.

Using linked administrative data across Medicare-subsidised visits and antibiotic prescriptions from PLIDA, we show that the rate of prescribing antibiotics decreased among GPs that adopted telemedicine more intensely, compared to those who adopted it less intensely. The identified decrease is around 5% and persists over time – after the COVID-19 pandemic. One potential explanation is that telemedicine can make it easier for GPs to schedule quick follow-up appointments, reducing the need for ‘just in case’ prescriptions, while also improving time efficiency in consultations, which may lessen reliance on antibiotics as a substitute for limited time.