Comparison of eVisit Management of Urinary Symptoms and Urinary Tract Infections with Standard Care
Abstract
Background: Urinary symptoms and urinary tract infections (UTIs) are common complaints for which women seek health care. Evolving modalities of care delivery have shifted management of these complaints from in-person face-to-face (F2F) visits, to nurse phone protocol management, and recently to online assessment via eVisit. While research has vetted the use of nurse phone protocol management, eVisit management outcomes have not been thoroughly studied. Purpose: To compare antibiotic prescribing, follow-up rates, and clinical outcomes between F2F visits at a retail clinic, nurse phone protocol encounters, and eVisits for the assessment and management of urinary symptoms and UTIs. Methods: A retrospective chart review of primary care empaneled patients at Mayo Clinic Rochester was conducted of females, 18 to 65 years old, who sought care for urinary symptoms via phone, eVisit, or F2F visit from August 1, 2016, through May 1, 2017. A total of 450 encounters, 150 from each of the 3 encounter types, were manually reviewed and compared for antibiotic prescribing rates, clinical outcomes, and 30-day follow-up rates. Results: Antibiotic prescribing rates for all three encounter types were similar. Referral for follow-up at initial encounter was more likely to be recommended from phone and eVisit encounters than F2F. No significant differences in follow-up rates or clinical outcomes were noted between the three encounter types. Conclusions: eVisits for urinary symptoms and UTI offer patients a convenient option for care without an increased use of antimicrobials, follow-up, or adverse clinical outcomes when compared with F2F visits or nurse-administered phone protocols.
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Four included studies lacked adjustment for any confounding factors.
“Additionally, 4 studies lacked adjustment for any confounding factors [16,18,20,23].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
Two moderate-quality studies, an RCT and a retrospective cohort study, found no significant difference in antibiotic prescribing rate between remote and face-to-face settings.
“Additionally, 2 moderate-quality studies, an RCT and a retrospective cohort study, noted no significant difference in prescribing rate between the different settings [18,21].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
Murray et al 2019 reported that for urinary tract infection, the antibiotic-prescribing rate in telephone consultations was 81% in remote consultations versus 83% in face-to-face consultations (P=.76).
“Intervention: 81%, control: 83% (P=.76)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
Murray et al 2019 reported that for urinary tract infection, the antibiotic-prescribing rate from text-based e-visits was 81% in remote consultations versus 83% in face-to-face consultations (P=.65).
“Intervention: 81%, control: 83% (P=.65)”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
Another moderate-quality study found no significant difference in antibiotic-prescribing rate for patients with UTI between remote and face-to-face consultations.
“Another moderate-quality study found no significant difference in antibiotic-prescribing rate for patients with UTI [18].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
Murray et al found no significant difference in antibiotic-prescribing rates in the initial consultation for patients who were followed up with.
“Further, Murray et al [18] found no significant difference in antibiotic-prescribing rates in the initial consultation for patients who were followed up with.”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
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 [18]
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 [18]
The studies examining specific indications for antibiotics suggested that antibiotic-prescribing rates for patients with UTI in remote consultations was higher than in face-to-face consultations, but 1 study did not find any difference.
“The studies examining specific indications for antibiotics suggested that antibiotic-prescribing rates for patients with UTI in remote consultations was higher than in face-to-face consultations, but 1 study did not find any difference [18].”
From Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (2020) · cites this paper as [18]
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- Authors
- Murray, M. A., Penza, K. S., Myers, J. F., Furst, J. W., & Pecina, J. L.
- Affiliations
- Mayo Clinic (US)
- Department of Family Medicine, Employee and Community Health, Rochester, Minnesota, USA.
- Corresponding author
- Murray, Martha A.
- Venue
- Telemedicine and e-Health
- Publisher
- SAGE Publications
- Published
- 2020-05-01
- Volume
- 26
- Issue
- 5
- Pages
- 639-644
- ISSN
- 1530-5627 (ISSN-L)
- 1556-3669
- OpenAlex
- W2957368575
- Cited by
- 39
- References
- 15
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 8 · 2023: 7 · 2022: 7 · 2021: 6 · 2020: 4
- FWCI
- 3.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Telemedicine Journal and e-Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- urinary tract infection, urinary symptoms, antibiotic prescribing, follow-up rates, telemedicine, women's health, primary care
- MeSH terms
- Adolescent, Adult, Aged, Female, Humans, Middle Aged, Primary Health Care, Retrospective Studies, Telephone, Urinary Tract Infections, Telemedicine, Young Adult
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