(HealthDay News) — For companies providing virtual visits for management of common acute illness there is significant variation in quality of care, according to a study published in JAMA Internal Medicine.

In an audit study, Adam J. Schoenfeld, MD, from the University of California in San Francisco, and colleagues examined the variation in the quality of urgent health care among virtual visit companies. Participants included 67 trained standardized patients who presented with 6 common acute illnesses: ankle pain, streptococcal pharyngitis, viral pharyngitis, acute rhinosinusitis, low back pain, and recurrent female urinary tract infection. 

The authors audited the 8 commercial virtual visit websites with the highest web traffic, for a total of 599 visits.

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The researchers found that histories and physical examinations were complete in 69.6% of visits, diagnoses were correctly named in 76.5%, and key management decisions were guideline-adherent in 54.3% of visits. 

Across the 8 websites, the rates of guideline-adherent care varied from 34.4% to 66.1%. Across-website variation was significantly greater for viral pharyngitis and acute rhinosinusitis than for streptococcal pharyngitis and low back pain or for ankle pain and recurrent urinary tract infection. 

There was no statistically significant variation noted in guideline adherence based on mode of communication (videoconference vs telephone vs webchat).

“Our study provides the first evaluation, to our knowledge, of the variation in quality of care currently being provided during commercial virtual visits,” the researchers wrote.


  1. Schoenfeld J, Davies JM, Marafino BJ, et al. Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits. JAMA Intern Med. 2016. doi:10.1001/jamainternmed.2015.8248.