mHealth Journal Club

Article Name: A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract Infections
Authors: Ateev Mehrotra, Suzanne Paone, G. Daniel Martich, Steven M. Albert, Grant J. Shevchik
Journal Published: Archives of Internal Medicine
Date Published: November 2012

Citation:

Mehrotra A, Paone S, Martich G, Albert SM, et al. A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract Infection. Arch Intern Med. 2012;():1-2.

Introduction:

E-patients have increased access to their providers and can virtually communicate about their problems in order to be assessed and receive treatment. However, criticism has been place on e-visits in that, due to the lack of face-to-face contact and hands on physical exam, quality of care is decreased and potential misdiagnosises can be made.

Objectives:

To compare the level of care between e-visits and office visits by reviewing 2 conditions: sinusitis and urinary tract infections (UTI).

Methods:

  • Office visits for between January 1, 2010 and May 1, 2011 included for analysis
  • Conducted at four primary care practices within the University of Pittsburgh Medical Center Health System with 63 internal medicine and family practice physicians
  • All e-visits and office visits for UTI and sinusitis included data obtained from EMR (EpicCare)
  • No data on statistical analysis provided

Results:

  • 5165 visits for Sinusitis
    • 465 (9%) were e-visits
  • 2954 visits for UTI
    • 99 (3%) were e-visits
  • No difference for follow-up for either condition or any other reason between e-visits or office visits
  • Physicians were not as likely to have a UTI-relevant test ordered for an e-visit compared to office visit (p<0.01).
  • Antibiotics were more likely to be prescribed for e-visits versus office visits (p<0.001), and followed along with guideline recommendations.

Study Conclusion:

The authors concluded the study demonstrated that follow-up does not appear to differ between e-patients or office patients. This may indicate that the quality of care is relatively equal. However,  the implication of an increased prescribing of antibiotics for e-patients is a concern that should be addressed in future practice.

The applicability of using e-visits could help reduce overall costs in healthcare, however, cost was not assessed directly. Limitations included: patients identified based on diagnosis code and not symptoms, captured only follow-up visits, did not assess resolution of symptoms or illness.

Commentary & Implication to mHealth:

The implication of this study is that hopefully others will look into larger comparison of the treatment of e-patients. This is especially relevant with the rise in smartphones and the ability to do video-chats and patients can show their provider the issue at hand. Perhaps we will see students in the future being taught to do virtual exams where the patient uses their phone from a distance.

However, the issue of what diseases warrant treatment virtually should be considered. What is concerning in this study is the higher prescribing of antibiotics for e-patients. While this may be secondary to no direct access to the patient and the physician wanting to cover the patient to be sure, it does raise the issue of collateral damage in regard to inappropriate antibiotic use.

Additionally, while follow-up was no different, the question remains how beneficial would a physical exam and tests have played in treatment and perhaps reduction in prescribing of treatment.

This alone is a topic of discussion in light of the growing rate of resistant pathogens and the decrease in the effectiveness of our drugs. Should our guidelines incorporate a standard for prescribing for e-patients, perhaps as to a best practice approach–and not only in the realm of infectious disease, but perhaps for other diseases? Lastly, should we consider e-visits as a preliminary care to determine whether patients should come in for an actual office visit?

Lets see what future studies bring.

References:
None

Links:
Archives of Internal Medicine – Research Letter