Antibiotic prescribing rates raise concerns over e-visits

E-visits offer a comparable standard of care to traditional physician office visits but antibiotic prescribing rates are higher, particularly for urinary tract infections (UTIs), say US investigators.

"Our findings refute some concerns about e-visits but support others," says Ateev Mehrotra, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues in the Archives of Internal Medicine.

Describing the high antibiotic prescribing rates for sinusitis at both e-visits and office visits as "a concern given the unclear benefit of antibiotic therapy for sinusitis," they add: "Our results highlight key differences between office visits and e-visits and emphasize the need to assess the clinical impact of e-visits as their popularity grows."

The team studied 5165 visits for sinusitis and 2954 visits for UTI at four primary care practices between 2010 and 2011. Of the sinusitis visits, 9% were e-visits, while 3% of the UTI visits were e-visits.

Patients were significantly less likely to consult their designated primary care provider at an e-visit than at an office visit, at 39% versus 42% for sinusitis, and 40% versus 64% for UTI. There were no significant differences in the number of follow-up visits in the subsequent 3 weeks for the same condition, suggesting comparable diagnostic accuracy for both types of visits.

Relevant tests for the condition were significantly more likely to be ordered at office visits than at e-visits for UTI, at 8% versus 51%. The difference was also significant for sinusitis visits, at 0% versus 1%. Specifically, urine culture was significantly more likely to be ordered at a UTI office than e-visit, at 31% versus 7%.

For both sinusitis and UTI visits, any oral antibiotic was significantly more likely to be prescribed at an e-visit than at an office visit, at 99% versus 94% for a sinusitis visit and 99% versus 49% for a UTI visit.

Furthermore, preventive care was significantly less likely to be ordered at an e-visit than an office visit, at 3% versus 0% for a sinusitis visit, and 7% versus 0% for a UTI visit. The pattern was replicated when the team looked specifically at chronic disease test, when the figures were 4% versus 0%, and 7% versus 1%, respectively.

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