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Direct-to-consumer Telemedicine & eVisits

Some existing health care systems as well as private companies such as Teladoc, American Well, and Doctor on Demand now offer patients around-the-clock “virtual” access to physicians for minor illnesses, rashes, or behavioral health issues. Patients can access these visits via phone call or videoconferencing on their smartphone, tablet, or laptop. On-demand access to health care providers through personal devices represents a new type of telemedicine: direct-to consumer (DTC) telemedicine. 

As suggested by its name, DTC telemedicine is distinct from other forms of telehealth in that the patient initiates the care and is the direct recipient. In synchronous DTC telemedicine visits, the interaction between clinician and patients is live via audio only or a two-way video. In asynchronous or “store and forward” visits, the transfer of information back and forth between patient and clinician is not in real time. With DTC telemedicine, asynchronous visits are generally called eVisits, although there is no consensus on this terminology. In an eVisit, patients generally answer a series of questions about their condition. This written information is sent to clinicians who make a diagnosis, prescribe the necessary care, and reply to the patients.

In our work, we have examined various aspects of DTC telemedicine:

Overview of Drivers and Estimation of Time Spent Traveling/Waiting for In-person Visits

  • Ray K, Mehrotra A. Opportunity Costs of Ambulatory Medical Care in the United States, AJMC. 2015 Aug;21(8):567-74.
  • Mehrotra A. The Convenience Revolution for Treatment of Low-Acuity Conditions. JAMA. 2013;310(1):35-36.

Here is a video that summarizes our findings in this area: https://www.youtube.com/watch?v=7Ot-LpNEWJY

Quality

  • Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018;178(6):782-789. PMCID: PMC6145753.
  • Schoenfeld, Adam J., Jason M. Davies, Ben J. Marafino, Mitzi Dean, Colette DeJong, Naomi S. Bardach, Dhruv S. Kazi, et al. “Variation in Quality of Urgent Health Care Provided During Commercial Virtual Visits.” JAMA Internal Medicine 176, no. 5 (May 1, 2016): 635–42. doi:10.1001/jamainternmed.2015.8248
  • Uscher-Pines, Lori, Andrew Mulcahy, David Cowling, Gerald Hunter, Rachel Burns, and Ateev Mehrotra. “Access and Quality of Care in Direct-to-Consumer Telemedicine.” Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association 22, no. 4 (April 2016): 282–87. doi:10.1089/tmj.2015.0079.
  • Uscher-Pines, Lori, Andrew Mulcahy, David Cowling, Gerald Hunter, Rachel Burns, and Ateev Mehrotra. “Antibiotic Prescribing for Acute Respiratory Infections in Direct-to-Consumer Telemedicine Visits.” JAMA Internal Medicine 175, no. 7 (July 1, 2015): 1234–35. doi:10.1001/jamainternmed.2015.2024.
  • Mehrotra, Ateev, Suzanne Paone, G. Daniel Martich, Steven M. Albert, and Grant J. Shevchik. “A Comparison of Care at eVisits and Physician Office Visits for Sinusitis and Urinary Tract Infections.” JAMA Internal Medicine 173, no. 1 (January 14, 2013): 72–74. doi:10.1001/2013.jamainternmed.305.

Access

  • Ray KN, Shi Z, Gidengil CA, Poon SJ, Uscher-Pines L, Mehrotra A. Antibiotic Prescribing During Pediatric Direct-to-Consumer Telemedicine Visits. Pediatrics. 2019;143(5):e20190631.
  • Ray KN, Shi Z, Poon SJ, Uscher-Pines L, Mehrotra A. Use of Commercial Direct-to-Consumer Telemedicine by Children. Acad Pediatr. 2019 Jan 10. S1876-2859(18)30517-5.
  • Shi Z, Mehrotra A, Gidengil C, Poon SJ, Uscher-Pines L, Ray KN. Quality of care for acute respiratory infections during direct-to-consumer telemedicine visits for adults. Health Affairs. 2018 Dec;37(12):2014-2023.
  • Uscher-Pines L, Fischer S, Tong I, Mehrotra A, Malsberger R, Ray K. Virtual First Responders: the Role of Direct-to-Consumer Telemedicine in Caring for People Impacted by Natural Disasters. J Gen Intern Med. 2018;33(8):1242-1244. PMCID: PMC6082207.
  • Uscher-Pines, Lori, Andrew Mulcahy, David Cowling, Gerald Hunter, Rachel Burns, and Ateev Mehrotra. “Access and Quality of Care in Direct-to-Consumer Telemedicine.” Telemedicine Journal and E-Health: The Official Journal of the American Telemedicine Association 22, no. 4 (April 2016): 282–87. doi:10.1089/tmj.2015.0079.
  • Uscher-Pines, Lori, and Ateev Mehrotra. “Analysis Of Teladoc Use Seems To Indicate Expanded Access To Care For Patients Without Prior Connection To A Provider.” Health Affairs 33, no. 2 (February 1, 2014): 258–64. doi:10.1377/hlthaff.2013.0989.
  • Mehrotra A, Paone S, Martich GD, Albert SM, Shevchik GJ. Characteristics of Patients Who Seek Care via eVisits Instead of Office Visits. Telemed J E Health. 2013 May 19. PMCID: PMC3699891

Spending

  • Scott Ashwood, Ateev Mehrotra, Lori-Uscher Pines, Direct-to-consumer telehealth may increase access to care but does not decrease spending, Health Affairs, 2017