New study tests the impact of home tests on clinical decision-making during telehealth visits

With the popularity of telehealth on the rise, more tools are in development to help physicians on the other side of the screen make diagnosis and treatment decisions.

In a new study, researchers at the University of Georgia and the University of Washington tested the impact of at home flu test results on how physicians tested and treated for influenza in telehealth patients.

The addition of at home test results, they found, helped physicians more confidently rule out flu or decide to prescribe flu treatment.

Mark Ebell, MD

“You could eliminate a lot of patients having to come in for visits, because the doctor would feel more confident that they were either ruled out or ruled in for flu,” said corresponding author Mark Ebell, professor of epidemiology and biostatistics at UGA’s College of Public Health.

Traditionally, physicians would diagnose flu patients during an office visit based on the patient’s symptoms and, perhaps, with a flu test. Now, with the rise of telehealth, deciding whether a patient is sick with flu or sick enough to need treatment, with Tamiflu, for example – may be more difficult.

In some cases, a physician may ask a patient to take an additional step to come into the office to get a flu test to be sure.

The study aimed to shed some light on how the addition of more information, namely home test results, would impact that decision-making process.

The researchers presented 202 physicians with a series of realistic scenarios where they were asked to determine how likely it was that a given patient had the flu, based on their reported symptoms and the current level of flu in the community, and whether they would rule out flu, have them come to the office for a test, or diagnose the flu without further testing.

Ebell says that each physician has a threshold, or tipping point, where they may decide to test, treat or rule out the possibility of a certain disease. For this study, Ebell and his co-authors established an average threshold to test, treat or rule out a patient for flu based on the clinical decisions participants made.

Then, they tested how the clinical decisions changed once the participants were presented with the results – positive or negative – of an at home flu test.

Not surprisingly, the additional results made a difference. About half of the physicians moved out of the middle zone where they felt the patient should come to the office for a flu test to definitively ruling out flu or prescribing treatment.

While at home flu tests are not yet available on the market, this work shows the potential for these tests to reduce office visits and the chances of a sick patient infecting others.

“I think one of the big advantages is when you take people with flu and have them come into your office, they’re sitting in a waiting room with a bunch of people who don’t have the flu. You’re reducing the burden on the community,” said Ebell.

The study, “The impact of a rapid home test on telehealth decision-making for influenza: a clinical vignette study,” was published recently in BMC Primary Care. The paper is available online here. The work was funded by a grant from Gates Ventures.

– Lauren Baggett

Posted on May 9, 2022.