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Virtual physician visits for urgent care vary in quality

Care quality among companies that offer virtual physician visits varied significantly, according to data recently published in JAMA Internal Medicine.

Companies that offer virtual visits have grown rapidly and so has acceptance by payers, Adam J. Schoenfeld, MD, of Philip R. Institute for Health Policy Studies, University of California, San Francisco, and colleagues wrote. The quality of care in these visits will partly dictate how urgently regulatory and industry standards need to be developed.

"Commercial virtual visits are a new form of physician-patient interaction in which patients use websites to request synchronous (live) consultation — via video-conference, telephone, or webchat — with a physician whom they have not met previously," they wrote.

"Virtual visits may be appealing because difficulty accessing timely care for acute problems (primary care practices, retail clinics and urgent care centers) is common. In 2013, less than half of U.S. adults reported being able to get same- or next-day appointments with their physicians and less than 40% reported being able to get care after hours without going to the emergency department."

The researchers investigated eight commercial virtual visit companies that were identified as the most frequently visited: NowClinic, Ameridoc, MeMD, Amwell, MDLIVE, Consult a Doctor, MDAligne and Doctor on Demand. They used 67 participants who were trained as standardized patients. The participants included actors who had previous training as standardized patients and students currently in medical school.

The participants approached one of the eight companies with one of six common acute illnesses: recurrent female urinary tract infection, viral pharyngitis, acute rhinosinusitis, low back pain, ankle pain or streptococcal pharyngitis. They completed 599 virtual visits with internal medicine physicians, emergency medicine physicians or family practice physicians.

Data showed that physicians completed the recommended patient histories and physical examinations in 417 visits (69.6%; 95% CI, 67.7-71.6). Patients were correctly diagnosed in 458 visits (76.5%; 95% CI, 72.9-79.9), and physicians adhered to guidelines when making key management decisions in 325 visits (54.3%; 95% CI, 50.2-58.3).

The websites demonstrated greater variation in quality of care for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40.4%) or streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%).

Care that adhered to guidelines varied across the eight providers, ranging from 206 visits (34.4%) to 396 visits (66.1%). The researchers reported that adherence to guidelines did not vary statistically by mode of communication.

"Our study provides the first evaluation, to our knowledge, of the variation in quality of care currently being provided during commercial virtual visits," Schoenfeld and colleagues concluded. "We found a significant variation across companies and by condition. The patterns of variation we observed imply an opportunity to improve and point toward approaches to determine how to make these improvements." – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.