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
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.