Remote versus in-person consultations for acute cystitis: antibiotic treatment and clinical outcomes, a retrospective cohort study.

Abstract

The COVID-19 pandemic brought a surge of remote consultations in Norwegian primary care with unknown implications for antibiotic treatment and outcomes of acute cystitis. To examine whether there were differences in antibiotic treatment or repeat contacts for acute cystitis between remote and in-person consultations. A retrospective cohort study was undertaken. For the 4-year period from 2018-2021, we linked individual registry data on all contacts for cystitis by women aged ≥16 years in general practice and out-of-hours (OOH) services in Norway with registry data on dispensed antibiotics. Index consultations for cystitis episodes were identified when there had been no urinary tract infection-related contacts or antibiotics dispensed at least 2 weeks before the consultation. We compared index remote versus index in-person consultations by antibiotic treatment within 3 days and repeat contacts within 14 days. Remote consultations were defined as consultations by text, telephone, or video. Remote consultations for acute cystitis increased markedly, from 0.5% of acute cystitis consultations in 2018 to 15.2% in 2021. Index remote consultations were associated with more second-line antibiotic treatment (adjusted relative risk [aRR] 1.04, 95% confidence interval [CI] = 1.02 to 1.06, <i>P</i><0.001), and more repeat contacts (aRR 1.11, 95% CI = 1.09 to 1.12, <i>P</i><0.001) than in-person consultations. For acute cystitis, index remote consultations are associated with more second-line antibiotic treatment and more repeat contacts than in-person consultations. The unique time-period of the COVID-19 pandemic and the regular GP scheme in Norwegian primary care must be considered when interpreting these findings.