title: Antibiotic prescribing by telephone in primary care.
abstract: OBJECTIVE
  Little is known about the contribution of telephone-based prescribing on overall antibiotic utilization. The objective of this study was to determine the extent and characteristics of telephone-based antibiotic prescribing in teaching and non-teaching primary care practices.
  
  
  METHODS
  This retrospective cohort study included all patients (n = 114 610) cared for by teaching and non-teaching internal medicine, pediatrics, family practice, and obstetrics/gynecology practices (n = 19) affiliated with a large US healthcare system during 2006-2010 and using a common electronic medical record. Rates and types of antibiotics prescribed by teaching and non-teaching practices via telephone contact and office visit were compared among the overall cohort. All telephone-related prescriptions during 2008 underwent chart review to determine indications for antibiotic prescribing.
  
  
  RESULTS
  Overall, 28.9 antibiotic prescriptions were issued per 100 patient-years, with 63 418 total antibiotic prescriptions and 7876 (12.4%) generated after telephone contact. Telephone-based prescribing increased steadily from 2.2 to 4.2 per 100 patient-years during the study period. Both telephone-based and office-based antibiotic prescribing were higher in non-teaching practices. Of 1790 antibiotics prescribed by telephone during 2008, the majority were for urinary tract infection (28.3%), sinusitis (20.1%), and unspecified upper respiratory infection (URI, 15.0%).
  
  
  CONCLUSIONS
  Overall, one in every eight antibiotics was prescribed via telephone encounter. These data highlight the need to include the impact of this practice in analysis of outcomes associated with outpatient antibiotic prescribing and to incorporate telephonic prescribing into guidelines facilitating appropriate antibiotic use.
authors: Department of Medicine, Value Institute, Christiana Care Health System, Newark, DE, USA.
authors: Edward
authors: E
authors: Ewen
authors: Vincent J
authors: VJ
authors: Willey
authors: Paul
authors: P
authors: Kolm
authors: William F
authors: WF
authors: McGhan
authors: Marci
authors: M
authors: Drees
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D055656:Prescriptions / Q000592:standards*; D011320:Primary Health Care; D012189:Retrospective Studies; D013689:Telephone; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: ambulatory care; infectious disease; pharmacoepidemiology; physician behavior; practice variation