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UPMC Study: E-Visits May Lead to Overprescribing

November 20, 2012
by Gabriel Perna
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According to a study from researchers at the University of Pittsburgh Medical Center (UPMC) and the University Of Pittsburgh School Of Medicine, patients who receive care through an e-visit may be overprescribed.

The study looked at four primary care practices at UPMC that use e-visits. It found that patients who use this technology were more likely to receive antibiotics before having relevant testing ordered than those who went for an in-person visit. The researchers looked at data from 5,165 visits for sinusitis and 2,954 visits for urinary tract infections (UTIs) from Jan. 1, 2010, to May 1, 2011. Nine percent of the visits for sinusitis and three percent for UTIs occurred through the Internet at these four practices.

“The main concern about e-visits, now offered in various forms by numerous health systems, has centered on quality  issues--specifically about whether physicians can make accurate diagnoses without a physical exam; whether the use of tests and follow-up visits is appropriate, and whether antibiotics might be overprescribed,” Ateev Mehrotra, M.D., author of the study, associate professor in internal medicine at Pitt’s School of Medicine and a researcher at the non-profit RAND corporation, said in a statement.

According to Mehrotra, when physicians cannot directly examine the patient they tend to take a ‘conservative’ route and order antibiotics. This was especially the case for UTIs, researchers found, where physicians examining a patient through an e-visit were less likely to order a urinalysis or urine culture, which can confirm a bacterial infection.

On a more positive note, the researchers said there was no difference in follow-up rates between regular visits and e-visits. Mehrotra also noted there were limitations to the study, because it captured only follow-up visits and not outcomes. The team also did not compare phone care, commonly provided in primary care practices, to electronic or office visits.

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