Virtual Care and Urinary Tract Infection Management

Abstract

Background: During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. Objectives: We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. Research Design: The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. Subjects: We included incident UTI encounters from adult primary care data from January 2019 to June 2021. Measures: Data were categorized as: prepandemic (January 2019–March 2020), COVID-19 Era 1 (April 2020–June 2020), and COVID-19 Era 2 (July 2020–June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. Results: We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. Conclusions: Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.

Did Access to Ambulatory Care Moderate the Associations Between Visit Mode and Ancillary Services Utilization Across the COVID-19 Pandemic Period?

“…In other studies, we found that order likelihood is lower for virtual than for in-person visits. 16,17 In this study, we found that 3 moderators that might influence patient treatment adherence did little to account for fulfillment disparities by visit mode.…”

“…16 An incident UTI visit was similarly defined, except the interval between visits was set at 90 days. 17…”

“…In prior analyses, we studied whether visit mode was associated with patient fulfillment of ancillary services orders and found a modestly-sometimes significantly-lower frequency with virtual versus in-person visits for neck or back pain (NBP) or urinary tract infection (UTI). 16,17 Our primary study objective was to evaluate if any of these 3 factors moderated the likelihood of patient fulfillment of ancillary services ordered by a physician on an ambulatory care visit differed by visit mode (virtual vs. in-person) or COVID-19 period [prepandemic (before beginning of the national emergency in April 2020) or recovery (after June 2020)].…”

“…Following the access to care framework of Aday, Andersen, and colleagues,13–15 we examined 3 factors—or moderators—of ancillary services order fulfillment: distance from residence to clinic, level of cost-sharing in service fulfillment defined by insurance plan benefits, and prior experience with pharmacy mail-order fulfillment as an alternative to facility-based fulfillment. In prior analyses, we studied whether visit mode was associated with patient fulfillment of ancillary services orders and found a modestly—sometimes significantly—lower frequency with virtual versus in-person visits for neck or back pain (NBP) or urinary tract infection (UTI) 16,17. Our primary study objective was to evaluate if any of these 3 factors moderated the likelihood of patient fulfillment of ancillary services ordered by a physician on an ambulatory care visit differed by visit mode (virtual vs. in-person) or COVID-19 period [prepandemic (before beginning of the national emergency in April 2020) or recovery (after June 2020)].…”

Assessing the Impact of Telemedicine Implementation in Diverse Health Care Systems

“…The KP research studies also tackle new areas in telemedicine research by comparing the impact of telemedicine and in-person visits on ancillary services utilization, including medication, laboratories, and imaging, for urinary tract infections7 neck and back pain,8 and depression 9. These studies found that although ancillary service orders resulting from telemedicine visits were generally high, orders from telemedicine encounters were not placed as often as in-person encounters for urinary tract infections, 7 neck and back pain, 8 but there were no significant changes in patient fulfillment of ordered antidepressant medications 9. The KP findings highlight the importance of prior use of mail-order pharmacy options in promoting the fulfillment of prescribed medication orders, irrespective of visit mode 10.…”