Blog | Tuesday, November 27, 2012

QD: News Every Day--Virtual diagnoses cost less, but more antibiotics prescribed

Virtual office visits for infections resulted in more prescribing of antibiotics, but could potentially lower health care costs, a study found.

Researchers studied four primary practices of the University of Pittsburgh Medical Center Health System that offered a secure online portal that allowed patients to answer questions about their condition. Based on this written information, physicians diagnose the infection, order care and reply to the patient.

To look at how care for virtual and in-office visits differed, researchers reviewer all office visits and e-visits for sinusitis and urinary tract infections (UTIs) from January 2010 to May 2011. Results appeared online at Archives of Internal Medicine:
--Physicians were less likely to order a UTI-relevant test at an e-visit (8% e-visits vs. 51% office visits; P less than .01);
--Few sinusitis-relevant tests were ordered for office or e-visits;
--Antibiotics were prescribed more often from and e-visit for either condition;
--For UTIs, antibiotics were prescribed 32% of the time when a urinalysis or urine culture was not ordered compared with 61% when the tests were ordered.

Researchers wrote, "When physicians cannot directly examine the patient, physicians may use a 'conservative' approach and order antibiotics. 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."

Rough cost estimates showed that lower reimbursement for the e-visits ($40 e-visit vs. $69 office visit) and the lower rate of testing ($11 urine culture) at e-visits outweighed the increase in prescriptions ($17 average prescription). Visits for UTIs was $74 for e-visits compared with $93 for office visits.