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E-visits could lead to overprescribing: study

By Joseph Conn
Posted: November 19, 2012 - 6:00 pm ET

In the short run, electronic visits with a physician appear to produce the same level of clinical care as in-person patient encounters, based on a study involving two medical conditions and one outcomes measure, researchers in Pittsburgh report. But the researchers' study, which looked at two medical conditions and one outcomes measure, found that down the road, e-visits via a personal health record may lead to problems with increased use of antibiotics.

The study, “A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract Infection,” published online in the Archives of Internal Medicine, examined the results of more than 8,100 patient visits to four primary-care practices at the University of Pittsburgh Medical Center Health System between Jan. 1, 2010, and May 1, 2011. The study cohort consisted of 5,165 visits for sinusitis, including 465 e-visits, or 9%; and 2,954 visits for urinary tract infections, including 99 e-visits, or 3%.

Among the researchers' “main concerns” about e-visits were questions of quality, such as whether physicians can make an accurate diagnosis absent a face-to-face interview or physical examination "and whether antibiotics might be overprescribed."

According to the study report, physicians were far less likely to order a UTI-relevant test for an e-visit than during an in-person encounter—8% for e-visits and 51% for in-office visits; and somewhat less likely to order tests, X-rays or CT scans for sinusitis with e-visits than in-person visits 0% vs. 1.2%.
Physicians also were more likely to prescribe an antibiotic for an e-visit than for an in-office visit. Oral antibiotics were prescribed 99% of the time for e-visits for patients with sinusitis and urinary tract infections, respectively, compared with prescribing them 94% of the time and 49% of the time during in-person encounters with patients who had those conditions, the researchers found.

According to a news release about the research, “there was no difference in how many patients had a follow-up visit either for that condition or for any other reason.”

“Follow-up rates are a rough proxy for misdiagnosis or treatment failure, so the lack of difference should be reassuring to patients and physicians,” lead author Dr. Ateev Mehrota, associate professor in internal medicine at the medical school, said in the release. “Medicare reimbursement for an e-visit was $40 compared with $69 for an office visit. Also, the lower rate of testing at e-visits outweighed the increase in prescriptions,” according to the news release. In total, it said, an e-visit for a urinary tract infection cost about $74 compared with $93 for an office visit.
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