A Comparison of Care at E-Visits and Physician Office Visits for Sinusitis and Urinary Tract Infection

Published in: JAMA Internal Medicine, v. 173, no. 1, Research Letters, Jan. 2013, p. 72-74

Posted on RAND.org on January 01, 2013

by Ateev Mehrotra, Suzanne Paone, G. Daniel Martich, Steven M. Albert, Grant J. Shevchik

Read More

Access further information on this document at JAMA Internal Medicine

This article was published outside of RAND. The full text of the article can be found at the link above.

The study compared care at e-visits and office visits for 2 conditions--sinusitis and urinary tract infection--at 4 primary care practices within the University of Pittsburgh Medical Center Health System, Pittsburgh, PA. Few sinusitis-relevant tests were ordered for either type of visit. 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. Physicians were more likely to prescribe an antibiotic at an e-visit for either condition. The antibiotic prescribed at either type of visit was equally likely to be guideline recommended. Among UTI office visits, the antibiotic prescribing rate was 32% when a urinalysis or urine culture was not ordered compared with 61% when a urinalysis or urine culture was ordered. During e-visits for both conditions, physicians were less likely to order preventive care. Study findings refute some concerns about e-visits but support others. The fraction of patients with any follow-up was similar for both types of visits. Antibiotic prescribing rates were higher at e-visits, particularly for UTIs. The high antibiotic prescribing rate for sinusitis for both e-visits and office visits is also a concern given the unclear benefit of antibiotic therapy for sinusitis. This study supports the idea that e-visits could lower health care costs. In total, the estimated cost of UTI visits was $74 for e-visits compared with $93 for office visits.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.