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. 2019 Oct 5;6(9):ofz393.
doi: 10.1093/ofid/ofz393. eCollection 2019 Sep.

Comparison of Diagnosis and Prescribing Practices Between Virtual Visits and Office Visits for Adults Diagnosed With Sinusitis Within a Primary Care Network

Kristen M Johnson  1 , Lisa E Dumkow  1 , Kayla W Burns  2 , Megan A Yee  3 , Nnaemeka E Egwuatu  4
Affiliations

Comparison of Diagnosis and Prescribing Practices Between Virtual Visits and Office Visits for Adults Diagnosed With Sinusitis Within a Primary Care Network

Kristen M Johnson et al. Open Forum Infect Dis. .

Abstract

Background: Many antibiotics prescribed in the outpatient setting result from upper respiratory tract infections (URTIs); however, these infections are often viral. Virtual visits have emerged as a popular alternative to office visits for URTIs and may be an important target for antimicrobial stewardship programs.

Methods: This retrospective cohort study evaluated adult patients diagnosed with sinusitis treated within a single primary care network. The primary objective was to compare guideline-concordant diagnosis between patients treated via virtual visits vs in-office visits. Guideline-concordant bacterial sinusitis diagnosis was based on national guideline recommendations. Secondary objectives included comparing guideline-concordant antibiotic prescribing between groups and 24-hour, 7-day, and 30-day revisits.

Results: A total of 350 patients were included in the study, with 175 in each group. Patients treated for sinusitis were more likely to receive a guideline-concordant diagnosis in the virtual visit group (69.1% vs 45.7%; P < .001). Additionally, patients who completed virtual visits were less likely to receive antibiotics (68.6% vs 94.3%; P < .001). Guideline-concordant antibiotic selection was similar between groups (67.5% vs 64.8%; P = .641). The median duration of therapy in both groups was 10 days (P = .88). Patients completing virtual visits were more likely to revisit for sinusitis within 24 hours (8% vs 1.7%; P = .006) and within 30 days (14.9% vs 7.4%; P = .027).

Conclusions: In adult patients presenting with sinusitis, care at a virtual visit was associated with an increase in guideline-concordant diagnosis and a decrease in antibiotic prescribing compared with in-office primary care visits. Virtual visit platforms may be a valuable tool for antimicrobial stewardship programs in the outpatient setting.

Keywords: antimicrobial stewardship; sinusitis; telemedicine; virtual visits.

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Figures

Figure 1.
Figure 1.
Mercy Health Saint Mary’s empiric therapy guidelines for sinusitis. Abbreviations: BID, twice daily; PO, oral.
Figure 2.
Figure 2.
Reported duration of symptoms.
See this image and copyright information in PMC

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