Virtual visits to doctor may be cheaper than and as effective as in-person visits

January 21, 2013

A new study suggests that “e-visits” to health-care providers for sinus infections and urinary tract infections (UTIs) may be cheaper than in-person office visits and similarly effective.

For e-visits, patients fill out online forms about their symptoms and a doctor or nurse gets back to them within a few hours with treatment advice.

In the study, the main difference between e-visits and office visits was that patients who received their care online were prescribed more antibiotics, a finding that could be concerning but is hard to interpret on its own, researchers said.

“All over the country, more and more of these e-visits are taking place,” said James Rohrer, a family medicine doctor at the Mayo Clinic in Rochester, Minn., who has studied online care.

Insurance companies believe e-visits will save money, he said. For patients, the biggest benefit is convenience.

“If you’re not feeling well, getting cleaned up and going into a clinic may not be too attractive,” said Rohrer, who wasn’t involved in the new research. And with e-visits, he added, “there are no parking problems.”

In the study, researchers compared more than 8,000 e-visits and office visits for sinus infections and UTIs at four primary-care practices in Pittsburgh between January 2010 and May 2011. More than 90 percent of appointments for both conditions were in-person office visits.

Ateev Mehrotra from the Rand Corp. and the University of Pittsburgh School of Medicine and his colleagues found that a similar proportion of patients — 7 percent or less in each case — had a follow-up visit for the same condition within the next three weeks. That suggests that misdiagnosis and treatment failure weren’t any higher with e-visits.

However, people who had opted for e-visits were more likely to be prescribed antibiotics than those who had in-person appointments. The effect was especially strong for UTIs: 99 percent of those patients who had an e-visit received an antibiotic, compared with 49 percent for those with an office visit.

That might be because doctors are more conservative with treatment when they can’t directly examine a patient, the researchers wrote in JAMA Internal Medicine. But it might also be worrisome, given that over-prescription of antibiotics is tied to drug resistance.

“That is something we really need to be careful about and watch for,” Mehrotra said.

Even with that difference in prescribing, treating each patient with a UTI cost an average of $74 per e-visit vs. $93 for an office visit, based on the researchers’ rough estimate.

Rohrer said some researchers still worry that doctors or nurses may miss some relevant information during an e-visit that would be clearer in a face-to-face appointment.

According to Mehrotra, the study’s findings are reassuring in that sense but don’t definitively show whether diagnoses are just as likely to be correct in an e-visit setting.

Rohrer said future studies should continue to look into the effectiveness of online care.

There are bound to be some kinks in the system or variation in e-visit quality while the concept is still being developed, he added. “This is clearly a moving target.”

— Reuters

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