Table 6.
Clinical studies evaluating applications of telehealth in urinary tract infections management.
| Reference | Study design | Cases | Studied intervention | Methods | Endpoint | Results |
|---|---|---|---|---|---|---|
| Schauberger (2007) [15] | Retrospective series | 273 | Telephone-based nurse protocol and treatment algorithm to evaluate women with symptoms of acute cystitis | Retrospective analysis of medical records of patients evaluated and treated according to a guideline-based algorithm for symptoms of acute cystitis | To evaluate the short-term (60-d) outcomes for women with symptoms of acute cystitis evaluated and treated with a telephone-based protocol | Of the patients, 75.4% being treated without urinalysis or cultures. Over the next 60 d, 46 (16.8%) were seen or made phone contact for recurrent or persistent urinary tract symptoms, with 6 (2.2%) diagnosed with pyelonephritis. No other adverse events were identified in the 60 d after the use of the protocol |
| Vinson (2007) [16] | Retrospective series | 4177 | Telephone management of UTI | Consecutive patients treated by a regional call center of a large group-model health maintenance organization were managed over the telephone for presumed cystitis with 3–7 d of oral antimicrobial therapy | To determine the factors associated with short-term risk for UTI recurrence after telephone management of cystitis | During the 6-wk follow-up period, 644 women (15.4) were diagnosed with UTI. Two factors were independently associated with recurrence in a Cox proportional hazards model: age ≥70 yr (p = 0.003) and antimicrobial selection (p = 0.031). Adjusted hazard ratios in reference to trimethoprim-sulfamethoxazole showed a significant risk reduction only with cephalexin: cephalexin, 0.75; ciprofloxacin, 0.85; and nitrofurantoin, 0.95 |
| Blozik (2011) [19] | Retrospective series | 526 | Use of telemedicine in females with uncomplicated UTI, with no contraindication for antibiotic therapy, if symptoms were present for <7 d and if the patient had no relevant comorbidity according to a predefined list | Consecutive UTI patients who had a teleconsultation including the prescription of an antibiotic were followed up 3 d later about symptom relief, adverse events, or the need to visit a doctor | The effectiveness and safety of telemedical management | Three days after teleconsultation:
In the 3 d following teleconsultation:
|
| Mehrotra (2013) [21] | Retrospective comparative | 99 | E-visits | We studied all e-visits and office visits at 4 primary care practices | To compare the care at e-visits and office visits for two conditions: sinusitis and UTI | Physicians were less likely to order a UTI-relevant test at an e-visit (8% e-visits vs 51% office visits; p < 0.01) |
| 2855 | Office visits | Physicians were more likely to prescribe an antibiotic at an e-visit (99% vs 49%, p < 0.001) | ||||
| There was no difference in the number of patients having a follow-up visit (7% in both groups, p = 0.98) | ||||||
| During e-visits, physicians were less likely to order preventive care (0% vs 7%, p = 0.02) | ||||||
| Rastogi (2020) [53] | Cross-sectional observational study | 20 600 | Utilization of telemedicine in patients seeking care for UTI | Recording general data and prescriptions in patients seeking care for or diagnosed with UTI via telemedicine | To describe the management of UTI in a large nationwide telemedicine platform | Of UTI patients, 94% received an antibiotic, 56% got nitrofurantoin, 29% got trimethoprim-sulfamethoxazole, and 10% got a quinolone. Receipt of an antibiotic was associated with higher satisfaction with care (p < 0.001). Antibiotic type varied by physician region. Of the 6% of the study population defined as high risk, 69% received an antibiotic: 72% men, 91% of women over 65 yr, and 21% of patients diagnosed with pyelonephritis |
UTI = urinary tract infection.