Virtual visits to doctors' offices yield good outcomes

Doctors who confer electronically with patients suffering from sinusitis and urinary tract infections correctly diagnose the infections at about the same rate as they do when seeing patients in their offices, yet they are more likely to prescribe antibiotics, according to a research letter published online this week in the Journal of the American Medical Association.

During e-visits, patients log into a doctors’ electronic health record system and answer electronically generated questions about their complaints, according to the letter. A doctor reviews the information, makes a diagnosis, orders appropriate care and responds to the patient via the portal within a few hours.

Doctors were less likely to order a test for a UTI during an e-visit than an office visit, but there was no significant difference in sinusitis-related tests for e-visits and office visits, according to the letter. Nor was there any difference in the number of follow-up visits for either type of condition, an indication that doctors had correctly diagnosed and treated patients.

The big difference in e-visits and office visits was in the rate of prescribing antibiotics, particularly for UTIs. “When physicians cannot directly examine the patient, physicians may take a ‘conservative’ approach and order antibiotics,” the researchers concluded. “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.”

E-visits were less costly than office visits, the researchers said—$74 versus $93 in the case of a UTI visit.

A JAMA subscription is required to view the entire research letter online.