A Comparison of Care at E-visits and Physician Office Visits for Sinusitis and Urinary Tract Infection
Open accessAbstract
Internet capabilities create the opportunity for eVisits, in which physicians and patients interact virtually instead of face-to-face. In an eVisit, a patient logs into her secure personal health record internet portal and answers a series of questions about her condition. This written information is sent to the physician, who makes a diagnosis, orders necessary care, puts a note in the patient’s electronic medical record (EMR), and replies to the patient via the secure portal within several hours. eVisits are offered by numerous health systems and are commonly reimbursed by health plans.1,2 eVisits typically focus on care for acute conditions, such as minor infections. There are several potential advantages of eVisits, including convenience and efficiency (avoiding travel and time) and lower costs.3 Further, eVisits can be provided by the patient’s primary care physician (PCP) instead of a physician at an emergency department or urgent care center. The main concerns about eVisits center on quality issues: whether physicians can make accurate diagnoses without a face-to-face interview or physical exam,4 whether use of tests and follow-up visits is appropriate, and whether antibiotics might be overprescribed. No studies have characterized the differences between eVisits and office visits. To fill this knowledge gap, we compared the care at eVisits and office visits for two conditions--sinusitis and urinary tract infection (UTI).
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We found 3 studies that reported the antibiotic-prescribing rate to be higher in remote settings than face-to-face consultations.
“We found 3 studies that reported the antibiotic-prescribing rate to be higher in remote settings than face-to-face consultations [19,22,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
The difference in antibiotic-prescribing rate between remote and face-to-face consultations ranged from 5% (n=201) to 50% (n=5165).
“The difference in prescribing rate ranged from 5% (n=201) to 50% (n=5165) [22].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
Mehrotra et al 2012 reported that for urinary tract infection, the antibiotic-prescribing rate was 99% in remote consultations versus 49% in face-to-face consultations (P<.001).
“Intervention: 99%, control: 49% (P<.001)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
Mehrotra et al 2012 reported that for sinusitis, the antibiotic-prescribing rate was 99% in remote consultations versus 94% in face-to-face consultations (P<.001).
“Intervention: 99%, control: 94% (P<.001)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
In Mehrotra et al, PCPs were less likely to order a UTI-relevant test in face-to-face consultations (did not order: 8%, did order: 51%; P<.01) but more likely to prescribe an antibiotic for UTI in remote consultations.
“Mehrotra et al [22] concluded that PCPs were less likely to order a UTI-relevant test in face-to-face consultations (did not order: 8%, did order: 51%; P<.01), but more likely to prescribe an antibiotic for UTI in remote consultations.”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
Of 2 studies assessing patients with suspected or confirmed UTI, 1 study found higher antibiotic-prescribing rates in remote consultations.
“Of 2 studies assessing patients with suspected or confirmed UTI, 1 study found higher antibiotic-prescribing rates in remote consultations [22].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
Guideline-concordant antibiotic management for sinusitis and patients with UTI revealed no significant difference between remote and face-to-face consultations.
“In contrast to the findings for antibiotic-prescribing rate, the guideline-concordant antibiotic management for sinusitis and patients with UTI revealed no significant difference between remote and face-to-face consultations [22,26].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations.
“In 3 studies, of which 2 were of high quality, researchers found higher antibiotic-prescribing rates in remote consultations than in direct PCP consultations [22,24,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
All 4 guideline-concordant prescribing studies were from the United States and investigated populations with confirmed sinusitis, UTI, or acute respiratory infection.
“All studies were from the United States and investigated populations with a confirmed diagnosis of sinusitis [22,26], UTI [22], or acute respiratory infection [25,27].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
The review found 4 observational studies that reported guideline-concordant or guideline-recommended prescribing rates, measuring appropriateness against local or national guidelines.
“We found 4 observational studies that reported guideline-concordant prescribing rates or guideline-recommended prescribing rates, which measured the appropriateness of the prescriptions against local or national guidelines [22,25-27] (Table 2).”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
The review found 5 US-based retrospective cohort studies that investigated follow-up visit rates after initial consultation for the same presentation.
“We found 5 US-based retrospective cohort studies that investigated follow-up visit rates after initial consultation for the same presentation [18,19,22,25,26].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
Murray et al and Mehrotra et al found no significant difference in follow-up visit rates between consultation types within the following 3 weeks and 30 days after the initial consultation, respectively.
“However, Murray et al [18] and Mehrotra et al [22] found no significant difference in follow-up visit rates between the consultation types within the following 3 weeks and 30 days after the initial consultation, respectively.”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [22]
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- Authors
- Mehrotra, A., Paone, S., Martich, G. D., Albert, S. M., & Shevchik, G. J.
- Affiliations
- University of Pittsburgh (US)
- UPMC Health System (US)
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-14
- Volume
- 173
- Issue
- 1
- Pages
- 72
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC3889474
- OpenAlex
- W2054939175
- Cited by
- 150
- References
- 5
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 6 · 2023: 18 · 2022: 17 · 2021: 14 · 2020: 17 · 2019: 15 · 2018: 12 · 2017: 9 · 2016: 10 · 2015: 11 · 2014: 6 · 2013: 3
- FWCI
- 6.18
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (KL2TR000146)
- National Institute of Allergy and Infectious Diseases (R21AI097759)
- National Center for Research Resources (KL2 RR24154-6, KL2RR024154)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- e-visits, telemedicine, physician visits, sinusitis, urinary tract infection, acute infection, primary care, antibiotic overprescription, diagnostic accuracy, health care costs, quality of care
- MeSH terms
- Anti-Bacterial Agents, Humans, Office Visits, Outcome and Process Assessment, Health Care, Physical Examination, Physician-Patient Relations, Practice Patterns, Physicians', Primary Health Care, Product Line Management, Sinusitis, Urinary Tract Infections, Remote Consultation, Internet, Electronic Health Records
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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