Patients Can Pick Up Respiratory Illnesses at the Doctor's Office

By Linda Carroll

August 04, 2021

(Reuters Health) - Patients who visited a doctor's office at the same time or after someone with flu-like illness were more likely than those who visited earlier in the day to return with a similar illness within two weeks, a new study finds.

An analysis of data from 10,737,587 office visits to nearly 7,000 physicians' offices between 2016 and 2017 revealed a 38% increase in return visits for influenza-like illness (ILI) by patients potentially exposed at the doctor's practice compared to patients who visited 90 minutes or more prior to the first ILI patient of the day, according to the report published in Health Affairs.

"We provide the first evidence that respiratory infection transmission happens within doctor's offices," said Hannah Neprash, an assistant professor of health policy and management at the University of Minnesota's School of Public Health in Minneapolis, who led the study.

"Specifically, we compared patients treated before versus after someone with the flu," Neprash said in an email. "Patients treated after were more likely to revisit for flu-like symptoms in the next two weeks."

While masking might help protect patients and physicians in encounters with sick patients, that may not be the best way to prevent the spread of respiratory illnesses, Neprash said. An "implication of our study is the importance of continued access to telemedicine visits, both for patients who might be contagious and for patients who might be particularly vulnerable to respiratory infections."

To explore the impact of running into a sick patient in the doctor's office, Neprash and her colleagues turned to data from athenahealth, Inc., a healthcare information technology company that provides cloud-based medical billing, electronic health records (EHRs), and practice management software to clinicians across the U.S.

The researchers analyzed deidentified billing and scheduling data for visits occurring at 6,709 office-based primary care practices, encompassing 105,462,600 primary care visits.

Among those visits, 10,737,587 (10.2%) occurred on the same date as an influenza-like illness visit at the same practice, with 3,394,777 (31.6%) occurring 90 minutes or more before a patient with an influenza-like illness and 7,342,810 (68.4%) occurring at the same time or afterward.

Patients treated before and after the ILI visit had similar demographic and insurance characteristics.

Within the study sample, 2.7 patients per 1,000 returned within two weeks with an influenza-like illness. Compared with the rate of return visits for patients treated before an ILI visit, patients treated after returned at a 0.7 per 1,000 greater rate, representing a 31.8% increase.

With more than 7.3 million visits taking place after an ILI visit, an additional 0.7 per 1,000 visits would add up to approximately 5,140 excess ILI visits potentially attributable to appointment timing, the researchers conclude.

"This study is 'big data' at work," Neprash said. "By working with large databases of EHR data - like this data from athenahealth, Inc. - researchers can get a much better understanding of how interconnected health care can be."

The results aren't surprising, said Dr. Raymond Pontzer, chief of the infectious disease section at the UPMC St. Margaret Hospital and a clinical associate professor at the University of Pittsburgh School of Medicine.

"I think it reinforces our preconceived notions," Dr. Pontzer said. "If a patient comes in contact in the waiting area with a person with a respiratory illness, they would be at higher risk of developing a respiratory illness. This shows how big data can be used."

It's very possible that the study underestimates the risk, Dr. Pontzer said. That's because it looks at all patients who came into the office after the patient with a respiratory illness. If the study were limited to only patients who were in the waiting room at the same time as the sick patient, the risk would probably be much higher, he said.

Moreover, the study is only looking at patients who came back to their primary care provider, so it's missing those who chose to go to an urgent care center or an emergency room, Dr. Pontzer said.

The study used data from a period of time before the pandemic, and it might be interesting to see if mask wearing in doctors' offices to prevent the spread of COVID-19 also prevented the spread of other respiratory diseases, Dr. Pontzer said.

SOURCE: https://bit.ly/2Vwe4Yn Health Affairs, online August 2, 2021.

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