This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
E-Visits Versus Office Visits -- Researchers Compare Care
By Sheri Porter
It's an important area of study given the growing popularity of e-visits, as well as the fact that insurers finally are getting onboard with payment for this alternative care venue.
According to the corresponding author for the study, Ateev Mehrotra, M.D., M.P.H., an assistant professor in the Division of General Internal Medicine at the University of Pittsburgh School of Medicine, "Increasingly, patients are receiving e-visits. If we offer a new drug, we always test. It is important to test new ways of delivering care in a similar way."
- Researchers conducted a study to compare the care patients received during electronic visits (e-visits) versus traditional office visits.
- The most significant finding was an uptick in the overall number of antibiotics prescribed during an e-visit for either condition.
- Patients' response to e-visits is positive, and e-visits have the potential to lower health care costs.
- Can physicians make a good diagnosis without actual patient contact?
- Are protocols pertaining to diagnostic testing and patient follow-up different for an e-visit versus an office visit?
- Do e-visits leave a trail of unnecessary antibiotic prescribing?
Study Methods, Key Findings Revealed
Researchers studied all e-visits and office visits for sinusitis and UTI between Jan. 1, 2010, and May 1, 2011, at four primary care practices associated with the University of Pittsburgh Medical Center. Using the institution's electronic health record, they tabulated 5,165 visits for sinusitis; of those, 465 (9 percent) were e-visits. In addition 2,954 patient visits were recorded for UTI, of which 99 (3 percent) were e-visits.
Researchers found, among other things, that physicians were
- less likely to order a UTI-relevant test during an e-visit (8 percent) versus an office visit (51 percent),
- more likely to prescribe an antibiotic for either condition during an e-visit, and
- less likely to order additional preventive care during an e-visit for either of the conditions.
"Our findings refute some concerns about e-visits but support others," wrote the authors. "The fraction of patients with any follow-up was similar. Follow-up rates are a rough proxy for misdiagnosis or treatment failure, and the lack of difference will therefore be reassuring to patients and physicians," they said.
Additionally, the authors noted, "Patients appear generally satisfied with e-visits."
However, higher antibiotic prescribing rates at e-visits were a cause for concern. "When physicians cannot directly examine the patient, physicians may use a 'conservative' approach and order antibiotics," wrote the authors.
They also reported that e-visits likely could lower health care spending. For example, using Medicare reimbursement data and previous studies, they estimated that the total cost of a UTI-related e-visit was $74; an office visit for the same complaint would total about $93.
Mehrotra said the study results should leave family physicians and other primary care health professionals with a heightened sense of awareness about the potential for increased antibiotic prescribing during e-visits.
"We need to keep monitoring the clinical outcomes," said Mehrotra. As for next steps, he said he would like to conduct a randomized trial of e-visits to better understand their effect on both patients and their physicians.
AAFP Policy/Guidelines Regarding e-Visits
Research Compares e-Visits Versus Office Visits