Trends in decision-making by primary care physicians regarding common infectious complaints

Area of Science:

• Public Health
• Epidemiology
• Primary Care Medicine

Background:

• The COVID-19 pandemic presented challenges for primary care physicians (PCPs) due to limited diagnostics and a shift to telehealth.
• PCPS experienced increased clinical decision-making uncertainty during the pandemic, particularly concerning respiratory assessments.

Purpose of the Study:

• To evaluate the pandemic's impact on PCP decisions, specifically referrals for chest X-rays, laboratory tests, and antibiotic prescriptions.
• To analyze changes in clinical decision-making patterns among primary care physicians in Southern Israel between 2018 and 2022.

Main Methods:

• A retrospective study analyzed 609,823 primary care visits for fever or cough across 209 clinics in Southern Israel (2018-2022).
• Multivariate generalized linear mixed-effects models were used to compare referral and prescription rates between pre-pandemic, pandemic, and post-pandemic periods, controlling for various factors.

Main Results:

• Social restrictions during COVID-19 correlated with decreased referrals and antibiotic prescriptions across all measured outcomes.
• Significant reductions were observed in throat culture referrals (OR=0.46) and cephalosporin prescriptions (OR=0.55) during lockdowns, especially in adults aged 20-59.
• These trends continued even after restrictions were lifted.

Conclusions:

• Primary care physicians maintained clinical decision-making processes despite pandemic-related uncertainty.
• The pandemic's associated restrictions led to a reduction in auxiliary resource utilization, potentially enhancing patient care quality.
• Reduced antibiotic prescribing and diagnostic testing can lower healthcare costs and aid in preventing future antibiotic resistance.