Self-diagnosis of uncomplicated urinary tract infections usually confirmed and treated via telemedicine visits

Reference

Rastogi R, Martinez KA, Gupta N, Rood M, Rothberg MB. Management of urinary tract infections in direct to consumer telemedicine. J Gen Intern Med 2020;35(3):643-648.

Synopsis

This study describes 20,600 telemedicine encounters over 2 years by patients who were seeking care through an Internet-based standalone national direct-to-consumer telemedicine service for a stated self-diagnosis of UTI (84%) or who were subsequently diagnosed with UTI. For the latter definition, the authors included patients with dysuria but for whom antibiotics were prescribed. Almost all (96%) of the calls were from women, with half between the ages of 18 years and 39 years; only 1% of the women were 65 years or older. Most (92%) of the patients with a self-diagnosis of UTI had that diagnosis confirmed by the clinician. Of these patients, 94% were prescribed an antibiotic. Six percent of the patients were defined as high risk (ie, being male, older than 65 years, or having pyelonephritis). Of these patients, 69% were prescribed an antibiotic. Almost 1 in 5 patients with pyelonephritis were treated with an antibiotic. Overall, 94% of the patients gave their physician the highest rating ("5 stars"), though the rates for this highest rating differed among patients who received an antibiotic (96%) and those who did not (85%; P <.001). The authors did not collect or report socioeconomic information about the patients, but we can infer that they were likely at the higher end since 88% had health insurance and the calls were initiated via a computer portal rather than by telephone. Most patients reported that they would have attended an urgent care clinic if telemedicine had not been available. Though not investigated in this current study, other studies have found a low risk of complications with telemedicine management .