Agreement Between Telehealth and In-Person Evaluations of Patients with Acute Respiratory Infections

How the absence of a physical examination in telehealth visits influences clinical decision-making in telehealth visits is not known. The aim of this study was to examine whether provision of patient self-collected vital signs influences telehealth management decisions for acute respiratory tract infections (ARIs). A consecutive sample of adult patients seeking care for ARIs completed a simulated telehealth visit either before or after their scheduled in-person evaluation. Patients were given instructions and devices to collect their vital signs before the telehealth visit. We compared the telehealth physician diagnostic and treatment recommendations with those made by the in-person treating physician. Forty-five patients completed the study. Compared to the in-person management decisions, telehealth evaluations yielded perfect agreement for when patients needed hospital admission. However, there was significant disagreement around the need for chest imaging and antibiotic treatment, with modest differences following the provision of patient self-collected vital signs.