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Electronic visits offer accurate diagnoses, may lead to overprescribing of antibiotics
Date:11/19/2012

oration. "Our findings refute some of these concerns and support others."

The researchers found that for each condition, there was no difference in how many patients had a follow-up visit either for that condition or for any other reason. "Follow-up rates are a rough proxy for misdiagnosis or treatment failure, so the lack of difference should be reassuring to patients and physicians," said Dr. Mehrotra.

However, on a less reassuring note, physicians were more likely to prescribe an antibiotic at an e-visit for either condition. "When physicians cannot directly examine the patient, they may be more likely to take a 'conservative' route and order antibiotics," Dr. Mehrotra said. This is a particular concern because misuse of antibiotics across the country is leading to an increase in drug-resistant germs.

For UTIs, the researchers found that physicians were less likely to order a urinalysis or urine culture, which can confirm a bacterial infection, after an e-visit (8 percent compared with 51 percent of office visits). Few sinusitis-relevant tests were ordered for either type of visit.

While Dr. Mehrotra and his team did not directly measure costs, Medicare reimbursement data and prior studies provide some evidence that e-visits have the potential to decrease health spending. For UTI visits, Medicare reimbursement for an e-visit was $40 compared with $69 for an office visit. Additionally, the lower rate of testing at e-visits outweighed the increase in prescriptions. In total, the estimated cost of UTI care was $74 for an e-visit compared to $93 for office visits.

Dr. Mehrotra cautioned that the study has some key limitations, including that it captured only follow-up visits, not outcomes, such as resolution of symptoms. The team also did not compare phone care, which is commonly provided in primary care practices, to electronic or office visits. "Our initial findings emphasize the need to continue assessing the clinical impact of e-visits as the
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Contact: Wendy Zellner
ZellnerWL@upmc.edu
412-586-9777
University of Pittsburgh Schools of the Health Sciences
Source:Eurekalert

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