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Choosing Wisely Talks | Are We Using Antibiotics Wisely in Primary Care in the Era of COVID-19? - Shared screen with speaker view
Douglas MacPherson
You are echoing
Jaana Ranchithan
Karen Riley
Wow. Family physicians in my area were not seeing patients during COVID. Any correlation?
Karen Born
Thanks for the comment @Karen Riley - our panel will be discussing just this question around the drivers of the drop of antibiotics prescriptions during the pandemic.
Karen Riley
Well as a pharmacist,,,,that would be my educated guess.
Evelyn Williams
what about driver of fewer respiratory infections because of social distancing and remote work? How do you separate possibly less disease vs decrease in visits/change to virtual care?
Karen Born
The revised cold standard tools were published in fall 2020 in BMJ as part of a series related to international Choosing Wisely recommendations link to article is here: https://www.bmj.com/content/371/bmj.m4125.long
Yvonne Jonk
We are seeing the opposite trend in hospital use of antibiotic use. More antibiotics used in hospitalized patients during COVID vs pre COVID.
Jaana Ranchithan
Please feel free to enter any questions or comments in the chat box.
Vandana Patel
Do you have any favourite go to OTC medications to cut short the timing of viral Sinusitis or influenza ?
Karen Born
FYI link to Cost of contact: redesigning healthcare in the age of COVID https://qualitysafety.bmj.com/content/30/3/236
Janet Reynolds
nasal corticosteroids can help alleviate acute sinusitis symptoms.
Steve Tait
How do we see lab tests like PCT, aiding in the identification of bacterial infection, impacting antibiotic prescription?
Janet Reynolds
over the counter decongestants, analgesia and antipyretics for symptom management, where appropriate are also helpful.
Karen Riley
Family physicians have been in a tough position. Patients have been afraid to go anywhere. Pharmacy is getting lots of calls about everything too.
Paul Philbrook
Won’t ongoing virtual care depend on Ministries of Health continuing to allow billing for such care?
Evelyn Williams
agree it all relates to allowed billing codes - pre-COVID primary care practitioners could not be paid for virtual care except if in certain group family practice models
The drop in antibiotic use of 40% looks like mainly access factor and patient demand factors. And physician- factors related to patient satisfaction. In a number of communities, the patient demand for antibiotics drives the prescriptions. Could any of the panelists address this aspect: the physician factor of wanting to give the patient confidence for ongoing continuity of care, and erroring on the side of over-prescribing?
Jerome Leis
Hi Steve Tait, PCT can be a helpful aid but is not a 'silver bullet' to addressing inappropriate antibiotics for RTI. Many patients who have clearly viral syndrome do not need any PCT testing at all and should be managed with viral prescription. There may be a subset of patients where concern about bacterial infection where testing is needed to rule out (eg. rapid strep for high centor score, CXR if concern about pneumonia...etc)
Karen Born
Check out delayed rx and viral rx in the Cold Standard tools https://choosingwiselycanada.org/campaign/antibiotics-primary-care
A Tsang
Often during virtual appointments, patients insist that they have a “strep” throat. I have directed those patients for an in-person visit. Does the panel feel that is appropriate?
Huda Almohri
We are a group of Infectious diseases physicians in Ontario who got together to develop ID Links, which ois a virtual Infectious Diseases Clinic. We see the referred patients on the same day or next day. From our statistics, we discontinued more antibiotics than starting new antibiotics. Extremely well received by patients and family physicians. We have the option of arranging to see the patients in person but we did not have to do that so far... This is another positive outcoome from the Pandemic..
Katherine Koroluk
Public Health Ontario has some great shared decision making tools for antibiotics in primary care!
Micheal Guirguis
in a virtual environment, the ability for patients to pressure to prescribe ABx may be a little less
Katherine Koroluk
Steve Tait
Thank you Dr. Lies. My question was more about procalcitonin vs other testing, rather than point of care.
marina malak
what if we dont have rapid strep in office?
Micheal Guirguis
can you speak of the Health counsel reports provided in Alberta
Jerome Leis
For procalcitonin the idea is similar. There are mixed results in terms of its utility in outpatient settings and the effect size is likely small. Some more basic 'low hanging fruit' is the stuff Karen spoke about like counseling the patient regarding diagnosis, natural history, safety net plan etc for people with viral syndromes - and tests like procalcitonin not needed in those cases.
n ab
Can you clarify how you deal with Strep Carrier Thanks
Micheal Guirguis
Janet Reynolds
Katherine Koroluk
Very interesting that the "duration letter" was more effective than the "overall use letter" in the OPTIMISE trial. Do you think that with the vast reductions in overall antibiotic use seen during the pandemic there will be a greater focus on the quality of antibiotic prescribing? This is much harder to address
Gillian Hurwitz
Link to BC eCoach (for MainPro credit): https://bccfp.bc.ca/professional-development/resources-for-all/cpd-ecoach/
Cindy Dumba
Patient partner here……I believe patient demand for potentially unnecessary antibiotics is greatly reduced by patient counselling. Many patients don’t understand the potential harms…..
Janet Reynolds
Great point Cindy!
Paul Philbrook
Absolutely agree Cindy. Many patients simply don’t understand that treating a viral infection with an antibiotic is useless and potentially harmful. Need to allocate a little time for patient counselling.
Jerome Leis
For a strep carrier, you treat the patient and not the result. If they have moderate-high predictive score they would be treated and if they don't then they should be considered colonized (that is not uncommon). The only time we treat colonized patients is if they are linked to a household case with invasive Group A strep infection (a rare scenario usually directed by public health), so as a rule carriers do not need antibiotics.
Jerome Leis
Thanks for this comment Cindy; Aligned with what we have heard repeatedly in this campaign
Jaana Ranchithan
Survey Link (English): https://www.surveymonkey.com/r/BTLZ7WQSurvey Link (French): https://fr.surveymonkey.com/r/BX56F9M
Sushma Mahajan
Jason Vanstone
Thank you all for the conversation.
Jaana Ranchithan
If you have any questions following this presentation, please email us at info@choosingwiselycanada.org.
Janet Reynolds
Take care everyone!