NEW YORK, Jul 09 (Reuters Health) -- Some uncomplicated cases of female urinary tract infection could be treated over the phone, according to Seattle researchers.
Nearly half of all women at some point suffer the symptoms of urinary tract infection (UTI), including pain, frequent urination, and bleeding. Such infections are the cause of 7 million doctor's visits every year, at a cost of $1 billion.
Since most of these infections are relatively "easily treated with standardized guidelines" -- a prescription of antibiotics -- the lab tests and doctor costs associated with uncomplicated bacteria-related infections are unnecessary in a high number of cases, according to researchers at the Group Health Cooperative, a managed care group in the Puget Sound region of Washington state.
In a new study, Dr. Sanjay Saint and colleagues offered women who called a clinic with the symptoms of a urinary tract infection the choice between a doctor visit, or a telephone consultation with a general practitioner or a specially-trained nurse.
Overall, 745 out of 4,000 women aged 18-55 were managed over the phone, and received prescriptions from the 22 test group clinics, according to the report in the American Journal of Medicine. A follow-up poll revealed the telephone antibiotic protocol had a high rate of patient satisfaction.
Not only were patients satisfied, but their compliance with recommended treatment was high, and there were "no significant changes in potential adverse effects," according to the report.
The authors estimate that the phone treatments saved nearly $350,000 "while maintaining, or improving the quality of care for patients."
However, doctors should know the patient's history before prescribing over the telephone, cautioned Dr. Ernest Kohorn, a urologist, obstetrician, and gynecologist at Yale University Medical Center.
In some cases, symptoms that appear to be a simple urinary tract infection could mask a more serious illness.
"If a patient walked in off the street, I would recommend a full consultation, and culture," he told Reuters Health. "If we had a medical history, that should be consulted. I may consult a patient over the phone if I know the patient well."
However, "if the infection is not cured within four days with antibiotics, then the patient may have another complication," said Kohorn.
The authors of the study did notice a trend towards a higher recurrence of sexually transmitted disease (STD), particularly chlamydia, in the telephone group-only group.
The trend was not very strong, and compared to the marked savings of time and laboratory costs, the authors did not make the increased STD incidence an issue, and suggested further investigation of this finding.
SOURCE: American Journal of Medicine 1999;106:635-641.
