Utilization, Safety, and Outcomes of Virtual Care for Urinary Tract Infections

The effects of increasing virtual care for urinary tract infections (UTIs) are unknown.

The objective of this study was to compare factors associated with and outcomes following virtual versus in-person UTI care.

This retrospective cohort identified all outpatient UTI encounters among adult women in a regional health system from 2015 to 2022. Virtual versus in-person visit, age, body mass index, self-identified race and ethnicity, median household income, Neighborhood Deprivation Index (NDI), Elixhauser Comorbidity Index (ECI), and UTI-related 30-day outcomes (hospitalization, emergency department [ED] visit, follow-up encounter) were extracted. Multivariate logistic regression identified factors associated with virtual versus in-person care and 30-day outcomes.

Sixty percent of 1,220,698 outpatient UTI encounters were virtual. Increasing income and age younger than 50 years were associated with the highest adjusted odds of virtual UTI care. Speaking Spanish or a language other than English and less deprived NDI were associated with lower odds of virtual care. There were 9,237 (0.8%) UTI-related hospitalizations, 20,680 (1.7%) UTI-related ED visits, and 279,668 (22.9%) additional outpatient encounters within 30 days, and all were less frequent following a virtual versus an in-person index UTI encounter. Age, ECI, and NDI were strongly associated with subsequent care utilization in multivariable models. A virtual index UTI encounter was associated with lower adjusted odds of an ED visit and higher adjusted odds of an additional outpatient encounter within 30 days.

Sociodemographic characteristics differ between those who access virtual versus in-person UTI care. Age, ECI, and social determinants of health are strong predictors of subsequent care within 30 days.