Electronic Visits for Minor Acute Illnesses: Analysis of Patient Demographics, Prescription Rates, and Follow-Up Care Within an Asynchronous Text-Based Online Visit

Penza, Kristine S; Murray, Martha A; Pecina, Jennifer L; Myers, Jane F.; Furst, Joseph W.

doi:10.1089/tmj.2017.0091

Cited by 24 publications

(34 citation statements)

References 14 publications

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“…There is growing evidence that patient-level disparities exist across adoption and usage patterns of patient portals [ 72 - 76 ]. Similarly, several studies in this review reported differences in usage based on sex [ 19 , 30 , 39 , 41 , 42 , 48 ], age [ 30 , 42 , 47 ], employment status [ 41 , 48 ], and ethnicity [ 19 , 41 ]. Since many patients access e-visits through the patient portal, which has known disparities in uptake [ 72 - 76 ], future studies are needed to test strategies for overcoming disparities in patient portal adoption.…”

Section: Discussionmentioning

confidence: 63%

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Nguyen¹,

Tabriz²,

Huo³

et al. 2021

J Med Internet Res

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Background Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. Objective To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. Methods We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impacts on clinical and health care delivery outcomes. Results Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. Conclusions Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.

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Section: Discussionmentioning

confidence: 63%

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Nguyen¹,

Tabriz²,

Huo³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…Conversely, there is also research to suggest that eVisits may increase health care utilization, drive up costs with follow-up visits, and often result in antibiotic overprescribing. 12 Studies have shown that management of other minor acute illnesses, such as uncomplicated infections of the urinary tract or upper respiratory infections (URIs), can be managed without an examination or f2f visit without risk of adverse outcomes, 9,11,[15][16][17][18][19][20] but there is limited evidence to establish that non-f2f visits for conjunctivitis have similar outcomes compared to traditional evaluation and management at an f2f encounter.…”

Section: Introductionmentioning

confidence: 99%

Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage

et al. 2018

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Objective The objective of this research paper is to compare antibiotic treatment, follow-up rates, and types of follow-up encounters among eVisits, phone calls, and in-person encounters for pediatric conjunctivitis. Study design A retrospective chart review of pediatric patients evaluated for conjunctivitis between May 1, 2016 and May 1, 2017, was performed. A total of 101 eVisits, 202 in-person retail clinic visits, and 202 nurse phone calls for conjunctivitis were manually reviewed for outcomes. Exclusion criteria included previous encounter for conjunctivitis in the past 14 days, treatment with an oral antibiotic at the initial encounter, or patient outside Minnesota at the time of encounter. Comparison among the three encounter types with regard to follow-up rates, follow-up encounter type within 14 days of initial evaluation, and prescribing rates was performed. Results Patients completing non-face-to-face encounters were significantly more likely to have follow-up care (34.6% and 45.5%) than those who had a face-to-face visit at the retail clinic (7.4%), p ≤ 0.0001. Patients initially evaluated by eVisit were more likely to have follow-up at the retail clinic while patients initially evaluated by phone call were more likely to have follow-up in their primary care office. Treatment rates with antibiotics were significantly higher in phone call encounters (41.6%) than in eVisits (25.7%) or face-to-face encounters (19.8%), p < 0.0001. Conclusions Non-face-to-face visits have significantly higher rates of follow-up when compared to face-to-face encounters. Antibiotic prescribing is greater with phone call triage encounters; however, there was no significant difference in antibiotic prescribing rates between eVisits and face-to-face visits. Follow-up type varied according to site of initial encounter.

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“…7 Virtual visits present an important ambulatory care target for ASPs outside traditional office visits; however, very little data currently exist regarding the appropriateness of antibiotic prescribing through virtual visits. 8,9 We compared the appropriateness of antimicrobial therapy between virtual visits and office visits for adult females diagnosed with uncomplicated UTIs within a primary care network.…”

mentioning

confidence: 99%

Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network

Johnson

Dumkow

Salvati

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objectives: Telemedicine visits are an increasingly popular method of care for mild infectious complaints, including uncomplicated urinary tract infections (UTIs), and they are an important target for antimicrobial stewardship programs (ASPs) to evaluate quality of prescribing. In this study, we compared antimicrobial prescribing in a primary care network for uncomplicated UTIs treated through virtual visits and at in-office visits. Design: Retrospective cohort study comparing guideline-concordant antibiotic prescribing for uncomplicated UTI between virtual visits and office visits. Setting: Primary care network composed of 44 outpatient sites and a single virtual visit platform. Patients: Adult female patients diagnosed with a UTI between January 1 and December 31, 2018. Methods: Virtual visit prescribing was compared to office visit prescribing, including agent, duration, and patient outcomes. The health system ASP provides annual education to all outpatient providers regarding local antibiogram trends and prescribing guidelines. Guideline-concordant therapy was assessed based on the network’s ASP guidelines. Results: In total, 350 patients were included, with 175 per group. Patients treated for a UTI through a virtual visit were more likely to receive a first-line antibiotic agent (74.9% vs 59.4%; P = .002) and guideline-concordant duration (100% vs 53.1%; P < .001). Patients treated through virtual visits were also less likely to have a urinalysis (0% vs 97.1%; P < .001) or urine culture (0% vs 73.1%; P < .001) ordered and were less likely to revisit within 7 days (5.1% vs 18.9%; P < .001). Conclusions: UTI care through a virtual visit was associated with more appropriate antimicrobial prescribing compared to office visits and decreased utilization of diagnostic and follow-up resources.

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Electronic Visits for Minor Acute Illnesses: Analysis of Patient Demographics, Prescription Rates, and Follow-Up Care Within an Asynchronous Text-Based Online Visit

Abstract: Most eVisits for minor acute illnesses can be completed without any further interaction with the healthcare system.

Cited by 24 publications

References 14 publications

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage

Comparison of diagnosis and prescribing practices between virtual visits and office visits for adults diagnosed with uncomplicated urinary tract infections within a primary care network

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