Quality of Virtual Healthcare Visits Vary Vastly

There is a significant variation in quality of urgent healthcare provided during virtual visits, according to a new study published in JAMA Internal Medicine. Especially for management of common acute illnesses, the variation stood true in the performance and not in the mode of communication.

Commercial virtual visits are an increasingly popular model of healthcare for the management of common acute illnesses. These virtual visits enable patients access a website to be connected synchronously—via videoconference, telephone, or webchat—to a physician with whom they have no prior relationship. So this has no in-person care option. Such virtual visits are becoming increasingly popular as they guarantee easy and timely access to care.

A very common complaint from patients is that when they really need urgent attention, they rarely get appointments on the same or next day. Having a virtual care option eliminates the time factor and enables urgent care by physicians.

The researchers conducted this study to better understand the variation in the quality of urgent healthcare among virtual visit companies.

Study Method and Results

For research purposes, only 6 common acute illnesses were considered: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. Data was collected from May 2013 to July 2014 from 67 trained standardized patients accessing 8 commercial virtual visit websites with the highest web traffic. All encounters were either through telephone or videoconferencing.

The final analysis was based on the completeness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions.

The authors found:

• Out of the 599 commercial virtual visits during the study period, histories and physical examinations were complete in 417 visits; diagnoses were correctly named in 458 visits; and key management decisions were adherent to guidelines in 325 visits.
• The encounters were varied: 372 videoconference encounters, 170 through telephone, and 57 through webchats.
• No significant variation was found in guideline adherence by mode of communication.
• In almost 14 percent of the encounters (83 patent visits), physicians made a referral to local brick-and-mortar healthcare providers. This was because either the scope of care was too large for online or for additional checkup.

Virtual Settings Need Improvement

It was found that the antibiotic prescription rates varied hugely in an online virtual setting compared with a traditional visit setting. The prescription rates were lower in a virtual setting. Antibiotic prescription is definitely an area that needs attention.

Another area that needs improvement is the rates of testing. In virtual settings, physicians didn't suggest patient to seek additional testings, which may not be a bad thing altogether, but needs to be looked into because sometimes appropriate use of testing is critical to the delivery of medical care and identification, the authors noted.

Commercial virtual visit companies are becoming hugely popular with a user base of almost 6 million people.

“The urgency of the need to develop a regulatory framework or industry-promulgated standards will depend, in part, on how much quality of care varies among virtual visit companies,” the researchers concluded.