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ImportanceCommercial virtual visits are an increasingly popular model of health care for the management of common acute illnesses. In commercial virtual visits, patients access a website to be connected synchronously-via videoconference, telephone, or webchat-to a physician with whom they have no prior relationship. To date, whether the care delivered through those websites is similar or quality varies among the sites has not been assessed.ObjectiveTo assess the variation in the quality of urgent health care among virtual visit companies.Design, setting, and participantsThis audit study used 67 trained standardized patients who presented to commercial virtual visit companies with the following 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. The 8 commercial virtual visit websites with the highest web traffic were selected for audit, for a total of 599 visits. Data were collected from May 1, 2013, to July 30, 2014, and analyzed from July 1, 2014, to September 1, 2015.Main outcomes and measuresCompleteness of histories and physical examinations, the correct diagnosis (vs an incorrect or no diagnosis), and adherence to guidelines of key management decisions.ResultsSixty-seven standardized patients completed 599 commercial virtual visits during the study period. Histories and physical examinations were complete in 417 visits (69.6%; 95% CI, 67.7%-71.6%); diagnoses were correctly named in 458 visits (76.5%; 95% CI, 72.9%-79.9%), and key management decisions were adherent to guidelines in 325 visits (54.3%; 95% CI, 50.2%-58.3%). Rates of guideline-adherent care ranged from 206 visits (34.4%) to 396 visits (66.1%) across the 8 websites. Variation across websites was significantly greater for viral pharyngitis and acute rhinosinusitis (adjusted rates, 12.8% to 82.1%) than for streptococcal pharyngitis and low back pain (adjusted rates, 74.6% to 96.5%) or ankle pain and recurrent urinary tract infection (adjusted rates, 3.4% to 40.4%). No statistically significant variation in guideline adherence by mode of communication (videoconference vs telephone vs webchat) was found.Conclusions and relevanceSignificant variation in quality was found among companies providing virtual visits for management of common acute illnesses. More variation was found in performance for some conditions than for others, but no variation by mode of communication.

Reducing Coronavirus disease 2019 (COVID-19) transmission relies on people quarantining after exposure to COVID-19 or if they experience COVID-19 symptoms, and isolating from others if COVID-19 positive. Quarantine and isolation last 10 to 14 days and can be state-mandated; however, the level of compliance is unknown. The University of Hawai'i Department of Family Medicine clinic called patients instructed by our physicians to quarantine for exposure risk or symptoms of potential COVID-19 infection between March 15, 2020, and April 15, 2020. None of the patients tested positive for COVID-19. Sixty-nine of 90 (77%) patients completed follow-up calls and self-reported whether they had stayed home. Of these 69 patients, 32 (46%) broke quarantine to buy groceries (36%), work (9%), visit others (6%), or for other reasons (12%). For patients living alone, 8 of 11 (73%) left home to buy groceries. For employed patients, 6 of 39 (15%) returned to work during their quarantine period. Nearly half of our patients did not quarantine for the entire period. Many persons left home to buy food or to work. Strong public health messaging is needed to educate communities about the requirement to quarantine. Clinicians can help by asking patients about social and financial ability to quarantine, schedule follow-up appointments to remind patients to stay home, and link patients to food programs, financial assistance, and other community resources to successfully quarantine and prevent COVID-19 transmission. [ABSTRACT FROM AUTHOR]

Reducing Coronavirus disease 2019 (COVID-19) transmission relies on people quarantining after exposure to COVID-19 or if they experience COVID-19 symptoms, and isolating from others if COVID-19 positive. Quarantine and isolation last 10 to 14 days and can be state-mandated; however, the level of compliance is unknown. The University of Hawai'i Department of Family Medicine clinic called patients instructed by our physicians to quarantine for exposure risk or symptoms of potential COVID-19 infection between March 15, 2020, and April 15, 2020. None of the patients tested positive for COVID-19. Sixty-nine of 90 (77%) patients completed follow-up calls and self-reported whether they had stayed home. Of these 69 patients, 32 (46%) broke quarantine to buy groceries (36%), work (9%), visit others (6%), or for other reasons (12%). For patients living alone, 8 of 11 (73%) left home to buy groceries. For employed patients, 6 of 39 (15%) returned to work during their quarantine period. Nearly half of our patients did not quarantine for the entire period. Many persons left home to buy food or to work. Strong public health messaging is needed to educate communities about the requirement to quarantine. Clinicians can help by asking patients about social and financial ability to quarantine, schedule follow-up appointments to remind patients to stay home, and link patients to food programs, financial assistance, and other community resources to successfully quarantine and prevent COVID-19 transmission., (©Copyright 2021 by University Health Partners of Hawai‘i (UHP Hawai‘i).)