The comparative effectiveness of telehealth versus primary care and collection of urine cultures on outcome in urinary tract infection
Abstract
Studies of urinary tract infection (UTI) treatment in telehealth settings have primarily evaluated young, healthy females. Urine culture collection is less common in telehealth settings but is recommended for all patients with potentially complicated infection. The aims of this study were: (1) to compare UTI-related clinical failure between telehealth and in-person primary care settings, and (2) evaluate if urine culture (UC) collection impacted UTI-related failure in patients with risk for antibiotic resistant infection. A retrospective cohort study of outpatients diagnosed with UTI between 2019 and 2021 in the Department of Veterans Affairs system was conducted. Inclusion required a telehealth or primary care visit with UTI International Classification of Diseases-Clinical Modification 10th revision code documentation and an antibiotic dispensed. Patients with recent UTI, concurrent indications for antibiotics, or where asymptomatic bacteriuria treatment was appropriate were excluded. Treatment failure was defined as combination of a new UTI-related outpatient visit or hospitalization that occurred between 3 to 30 days after the antibiotic dispense date. Antibiotic exposure data, covariates, hospitalization, and UC history were obtained. Overlap weighting and generalized estimating equation models estimated the relative risk of failure for clinical setting and for UC collection versus no collection. There were 16,266 telehealth and 29,296 primary care patient-visits…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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