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

Abstract

Background: 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. Aim: To examine whether there were differences in antibiotic treatment or repeat contacts for acute cystitis between remote and in-person consultations. Design & setting: 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. Method: 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. Results: 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, P<0.001), and more repeat contacts (aRR 1.11, 95% CI = 1.09 to 1.12, P<0.001) than in-person consultations. Conclusion: 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.