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 Researchers got 67 volunteers to test out how well eight popular
virtual visit companies diagnosed these problems and four other
common medical issues – sore throat, sinus infection, low back pain,
and urinary tract infection.
About one in four patients got the wrong diagnosis or none at all
from the virtual visits, the study found.
What’s more, virtual doctors followed standard protocols for
diagnosing and treating these problems only 54 percent of the time.
“One of the more surprising findings of the study was the
universally low rate of testing when it was needed,” said lead
researcher Dr. Adam Schoenfeld, of the University of California, San
Francisco.
“We don’t know why, but it may reflect the challenges of ordering or
following up on tests performed near where the patient lives but far
from where the doctor is, or concern about the costs to the patient
of additional testing,” Schoenfeld added by email.
Virtual visits using videoconferences, phone calls and web chats are
becoming a more common way for patients to seek urgent care because
it can save the inconvenience of a clinic visit or provide access to
care when people can’t get an appointment with their regular doctor.
Some insurers are starting to pay for virtual visits in certain
situations, making this option more viable for patients who worry
about costs.
For the current study, Schoenfeld and colleagues trained volunteers
to act as if they had common acute medical problems and then sent
them to virtual doctors provided by companies including Ameridoc,
Amwell, Consult a Doctor, Doctor on Demand, MDAligne, MDLIVE, MeMD
and NowClinic.
Altogether, the volunteers completed 599 virtual visits in 2013 and
2014.
The companies varied in how well they followed treatment guidelines,
with standard care given anywhere from 34 to 66 percent of the time
across the eight websites, the researchers report in JAMA Internal
Medicine.
Mode of communication – such as web chat or videoconference – didn’t
appear to influence how often treatment guidelines were followed.
Virtual doctors got complete histories and did thorough exams
anywhere from 52 percent to 82 percent of the time.
Virtual visits resulted in correct diagnoses anywhere from 65
percent to 94 percent of the time.
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Often, virtual doctors failed to order urine tests needed to assess
urinary tract infections, or to request images needed to diagnoses
ankle pain, for example, and antibiotics were often prescribed
inappropriately.
One limitation of the study is that the researchers only looked at
virtual visits, so they couldn’t compare these online doctors’
visits to what might have happened with in-person clinical exams.
Still, it’s possible that at least some of the variation in quality
of care was the result of the remote visits, said Dr. Jeffrey
Linder, a researcher at Brigham and Women’s Hospital and Harvard
Medical School who co-authored an editorial accompanying the study.
“There is a built-in barrier to getting testing, which led to worse
care for ankle pain and recurrent urinary tract infections – for
which the doctors should have ordered a test – and better care for
low back pain – for which doctors should not have ordered a test,”
Linder said by email.
In an ideal world, patients would be able to have occasional virtual
visits with their primary care providers, who know their medical
histories, said Dr. David Levine, co-author of the editorial and
also a researcher at Brigham and Women’s and Harvard.
“Although virtual urgent care and in-person urgent care have not
been compared head-to-head, virtual urgent care has its downsides –
indirect physical exam, difficult access to testing, and unclear
follow-up,” Levine said by email. “While the quality of care is not
perfect anywhere, a patient’s primary care doctor should be a
person’s first point of contact.”
SOURCE: http://bit.ly/1qk5Yxq JAMA Internal Medicine, online April
4, 2016.
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