Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits

Abstract

Importance Commercial virtual visits are an increasingly popular model of care for the management of common, acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously—via videoconference, telephone, or webchat—to a physician with whom they have no prior relationship. There has been no assessment of whether the care delivered through those websites is similar, or whether quality varies among the sites. Objective To assess the variation in quality of care among virtual visit companies. Design We performed an audit study using trained standardized patients. Setting The standardized patients presented to commercial virtual visit companies with six common, acute illnesses (ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent urinary tract infection). Participants The eight commercial virtual visit websites with the highest web traffic. Main Outcome Measures The primary outcomes were completeness of histories and physical examinations, naming the correct diagnosis (versus an incorrect diagnosis or not naming any diagnosis), and adherence to guidelines of key management decisions. Results Standardized patients completed 599 commercial virtual visits from May 2013 to July 2014. Histories and physical examinations were complete in 69.6% (95% confidence interval [CI], 67.7%-71.6%) of virtual visits, diagnoses were correctly named in 76.5% (CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 54.3% (CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 34.4% to 66.1% across the eight websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (12.8-82.1%) than for streptococcal pharyngitis and low back pain (74.6-96.5%) or ankle pain and recurrent urinary tract infection (3.4-40.4%). There was no statistically significant variation in guideline adherence by mode of communication (video vs. telephone vs. webchat). Conclusions We found significant variation in quality among companies providing virtual visits for management of common acute illnesses. There was more variation in performance for some conditions than for others, but there was no variation by mode of communication.

Patterns of Use and Correlates of Patient Satisfaction with a Large Nationwide Direct to Consumer Telemedicine Service

“…Indeed, substantial variation in the quality of telemedicine care has been reported. 25,26 To date, no study has described a large group of physicians who practice DTC telemedicine. The overwhelming majority of physicians in our sample were trained at US medical schools and were generalists.…”

Telemedical Education: Training Digital Natives in Telemedicine

“…For instance, Mehrotra et al [ 5 ] found that e-visits had roughly the same treatment outcomes as in-person visits for sinusitis and urinary tract infections, but e-visits had higher rates of antibiotic prescription. Schoenfeld et al [ 6 ] found considerable variation in the quality of care provided by commercial telemedicine companies. As more patients are seen remotely and indications for telemedicine become more complex, we need to train physicians to offer digital care on par with in-person consultation.…”

Patient preferences for direct-to-consumer telemedicine services: a nationwide survey

“…Real-time telemedicine can be delivered between two clinic sites (e.g., hospital to remote hospital/clinic) or directly between a care provider and the patient at home or work. Direct-to-consumer (DTC) telemedicine can provide immediate and convenient access to a care provider that usually costs less than a standard in-person urgent care or emergency room visit [3]. DTC telemedicine has also been shown to increase access to care to those without a primary care provider [4, 5].…”