Quality of e-visits not yet equal to office visits

Research that compares care given through virtual visits with care given in person at a physician’s office rebuts some of the concerns physicians have about e-visits while supporting other worries, says a Jan. 14 study in JAMA Internal Medicine, formerly Archives of Internal Medicine.

Study co-author Ateev Mehrotra, MD, assistant professor at the University of Pittsburgh School of Medicine and policy analyst for the RAND Corp., said patients have sought care from places such as retail clinics and emergency departments because they were able to access them immediately, without the wait they would have faced at a primary care physician’s office.

Although telehealth has been considered as an option to get those patients back, “the concern I always hear from my physician colleagues about these electronic visits is, ‘Can you really do this? Can you really accurately diagnose someone using these telemedicine options?’ ” Dr. Mehrotra said the study provides mixed evidence that you can (link).

The researchers compared visits for sinusitis and urinary tract infection at four primary care practices within the University of Pittsburgh Medical Center Health System that offer e-visits.

Of the 5,165 visits for sinusitis, 9% were e-visits, and of the 2,954 UTI visits, 3% were e-visits. For each condition, there was no difference in how many patients had follow-up visits either for that condition or for any other reason. On the other hand, they found that physicians were more likely to prescribe an antibiotic at an e-visit for either condition than they were for an actual visit.

To the degree that a follow-up would indicate that there was not a resolution to the patient’s problem, the finding that e-visits did not result in more follow-up care “is pretty positive,” Dr. Mehrotra said. But the fact that e-visit patients were prescribed more antibiotics might indicate that physicians were somewhat unsure of the diagnosis and prescribed antibiotics as a precaution, which could have negative consequences, he said.

Coming trend

Many practices already are heading toward implementing telehealth technology in their practices because of competitive pressure. This could be a valuable addition to the practice, researchers said. The study highlights some of the possible consequences to make sure they are being addressed, Dr. Mehrotra said.

The study authors say their data support the idea that e-visits could lower health care spending, an idea supported by many health insurers. WellPoint, UnitedHealth Group and various BlueCross BlueShield Assn.-affiliated plans have started offering patients the opportunity to receive care via telehealth and are paying physicians to provide it. Their goal is to reduce emergency department visits.

The telemedicine industry is expected to continue growing, with a market report by Massachusetts-based BCC Research predicting that the global telehealth market will grow from about $11.6 billion in 2011 to about $27.3 billion by 2016.