E-visits may result in cost savings and overprescribing

A comparison of care provided during virtual and physical interactions with providers revealed that e-visits could reduce healthcare costs despite their correlation with higher prescribing rates, according to research letter a published online Nov. 19 by the Archives of Internal Medicine.

Potential advantages of e-visits include convenience, efficiency and lower cost, but there are unanswered questions regarding whether physicians can make accurate diagnoses, whether testing and follow-up visits are appropriate and whether antibiotics might be over prescribed, according to the study's lead author Ateev Mehrotra, MD, MPH, associate professor of medicine at the University of Pittsburgh. To determine specific variations, Mehrota and his colleagues compared virtual and physical visits made to four primary care practices within the University of Pittsburgh Medical Center Health System.

Mehrotra and his colleagues examined all interactions for urinary tract infection (UTI) and sinusitis at the four practices occurring between Jan. 1, 2010 and May 1, 2011. Out of 5,165 total visits for sinusitis, 9 percent were e-visits, and out of 2,954 total visits for UTI, 3 percent were e-visits.

The results showed:

• 8 percent of e-visits resulted in physicians ordering UTI-relevant tests compared to 51 percent of office visits;
• 99 percent of e-visits for sinusitis resulted in physicians prescribing any oral antibiotic compared to 94 percent of office visits;
• 99 percent of e-visits for UTI resulted in physicians prescribing any oral antibiotic compared to 49 percent of office visits; and
• Fewer than 7 percent of both types of visits for either UTI or sinusitis resulted in a follow-up. 

Additionally, while researchers did not attempt to calculate cost savings, they estimated based on Medicare reimbursement data and previous research that the average cost of UTI visits was $74 for e-visits and $93 for office visits.

Based on the results, the researchers concluded that diagnoses were rarely inaccurate for either type of visit and that e-visits could lower healthcare spending, but that the the high prescribing rates associated with e-visits was a concern.

“When physicians cannot directly examine the patient, physicians may use a ‘conservative’ approach and order antibiotics,” wrote Mehrotra et al. “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.”

As more healthcare systems provide patients with virtual access, it will be important that future research further assess the clinical impact of e-visits, according to the researchers.