Virtual Physician Visits: Are They What We Thought?

Over the last few years, virtual physician care has been on the rise with the commercial virtual visit companies boasting millions in their user bases, and more and more insurance providers accepting this mode of care.

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This type of doctor visit is very appealing to patients because people are simply busy. Many have trouble getting an appointment with their doctor the same or next day, and they have to visit emergency clinics when they need care after hours. Some even say that this may be at the forefront of a “convenience revolution.” With all this, it may seem that calling or video chatting a doctor would be the best option, but would it?

The Study

JAMA Internal Medicine published a study with evidence that virtual physician visits may not be as great as we had originally thought. Using 67 trained standardized patients or “mystery shoppers”, they presented six common, acute illnesses to the eight commercial virtual visit websites with the highest web traffic.

The companies advertised that they were able to treat all six medical conditions. Over 599 visits to 157 internal medicine, emergency medicine, or family practice physicians were presented the illnesses of:

  • Ankle pain
  • Streptococcal pharyngitis
  • Viral pharyngitis
  • Acute rhinosinusitis
  • Low back pain
  • Female urinary tract infection

The point of the study was to determine the quality of care that is provided by commercial virtual visit companies. The study was able to conclude that there was significant variation between companies, which may have to do with the uncertainty of regulatory bodies. Because of limitations, there were a few shortcomings with the research.

  • There was no comparison to brick and mortar establishments.
  • The market only continues to evolve as virtual visits become more popular.
  • The exact market share of the companies studied was not known.

The Results

With patients entering into a situation where the doctor has no prior history with them, approximately 70% of encounters had the recommended history questions asked and examination maneuvers completed. That left around 30% of the patients with a diagnosis that wasn’t based off their medical history or appropriate examination!

virtual physician visits 1There were variances not only between companies, but also between conditions. Examination and history were more likely to be completed with lower back pain than ankle pain, and a UTI was more likely to be diagnosed correctly then rhinosinusitis. There were inconsistencies with how the companies performed with both viral pharyngitis and rhinosinusitis.

It was found that virtual visit companies are less likely to order tests across the board. In instances where tests should have been ordered, such as UTI urine test or ankle pain radiograph, only 34% of UTI visits and 16% of ankle pain visits has tests ordered. On the other hand, 93% correctly did not order a radiograph for lower back pain. Around 14% of patient encounters resulted in the physician referring them to a healthcare location because they did not think the case was within their scope or follow-up could be provided online.

As it turns out, the method of communication did not substantially impact the quality of care that patients received. Videoconference and telephone both had similar results.

What does this mean for virtual visits?

It is what the people want, so this sub-industry does not seem to be going anywhere. While some states have specific limitations of the type of care that can be provided during virtual visits, there are some states that have very minimal regulations.

The problem is that they have grown so fast. Regulation hasn’t been able to keep up, so there are inconsistencies in policy and care. The inconsistency between companies has a lot to do with their ownership or partnerships. A company partnered with a lab and imaging company will be more likely to recommended far more testing then necessary, and a company partnered with a pharmaceutical company will most likely distribute more prescriptions than what the patients actually need.

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There have been some steps forward in this area with the Federal Trade Commission not only having commented on the growth of virtual visits across states, but also on the uncertainty about what government agencies should have the authority to supervise them. The American Telemedicine Association is also in the process of developing voluntary standards for its members. While there is nothing really set in stone yet, it is promising to see that strides are being made.

Even so, it is what the people want? A regulatory body would add a big aspect of consistency to this new sub-industry. Quality of care is the most important, so why not find a way to make sure the patients receive the best care they can in an industry that continues to receive more business?


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