Digital Care Providers Antibiotic Prescribing Compared to Traditional Primary Healthcare: A Retrospective Database Study of 332,987 Healthcare Visits in Sweden.

Objectives: The aim of this study was to examine if there was a difference in antibiotic prescribing between private digital care providers, and traditional primary healthcare, and to investigate if the prescriptions differed regarding diagnosis between virtual visits and physical visits adjusted for age, sex, and place of residence for patients seeking care digitally and in person. Methods: Antibiotic prescribing based on ATC-codes during the period of two months in 2020 was studied. Prescriptions issued by online doctors and by physicians working within PHC Sörmland County, Sweden were considered. Information about healthcare provider, date of the visit, staff category that patient had contact with, ICD-10-diagnosis codes, ATC-codes of prescribed medicines and personal information such as: age, sex, and place of residence were used. Statistical analysis and logistic regression were performed. Results: Altogether 332,987 healthcare visits were registered. Of all visits to physicians at PHC in Region Sörmland, antibiotics were prescribed in 5.9% of cases, and 3.9% of all visits to online doctors. The total number of visits that led to infection diagnosis was 112,354. Within physical visits at PHC 21.5% infection visits ended with antibiotic prescription, while within online visits the corresponding percentage was 10.1%. Additionally, the study focused on seventeen infection diagnoses. Conclusion: This study has shown that private digital care providers do not prescribe more antibiotics than doctors at PHC. Probability of receiving antibiotic prescription during digital visits was 4.88 times lower compared to physical visits.