Direct-To-Consumer Telemedicine Can Miss Diagnoses, Lack Follow-Up Care

MedicalResearch.com Interview with:

Jack Resneck, Jr, MD Professor and Vice-Chair of Dermatology Core Faculty, Philip R. Lee Institute for Health Policy Studies UCSF School of Medicine

Dr. Jack Resneck

Jack Resneck, Jr, MD
Professor and Vice-Chair of Dermatology
Core Faculty, Philip R. Lee Institute for Health Policy Studies
UCSF School of Medicine

MedicalResearch.com: What is the background for this study?

What are the main findings?

Dr. Resneck: Telemedicine, when done right, can improve access and offer convenience to patients.  We have seen proven high-quality care in telemedicine services where patients are using digital platforms to communicate with their existing doctors who know them, and where doctors are getting teleconsultations from other specialists about their patients.  But our study shows major quality problems with the rapidly growing corporate direct-to-consumer services where patients send consults via the web or phone apps to clinicians they don’t know.

Most of these sites aren’t giving patients a choice of the clinician who will care for them or disclosing the credentials of those clinicians – patients should know whether their rash is being cared for by a board-certified dermatologist, a pain management specialist, or a nurse practitioner who usually works in an emergency department.  Some of these sites are even using doctors who aren’t licensed in the US.   We also found that these sites were regularly missing important diagnoses, and prescribing medications without discussing risks and side-effects, putting patients at risk.  We observed that if you upload photos of a highly contagious syphilis rash but state that you think you have psoriasis, most clinicians working for these direct-to-consumer sites will just agree with your self-diagnosis and prescribe psoriasis medications, leaving you with a contagious STD.

Perhaps the biggest problem with many of these sites is the lack of coordinating care for patients – most of them didn’t offer to send records to a patient’s existing local doctors.  And when patients end up needing in-person care if their condition worsens, or they have a medication side-effect, those distant clinicians often don’t have local contacts, and are unable to facilitate needed appointments.

MedicalResearch.com: What should readers take away from your report?

Dr. Resneck: Telemedicine is best performed by physicians and team members who are part of practices or regional systems in which patients already receive care.

Many insurers are currently contracting with these direct-to-consumer services for their enrollees, while refusing to cover follow-up telehealth visits with a patient’s existing doctors, and that’s a problem.

Physicians are strong proponents of innovation where the value is proven for quality care to patients, and telemedicine has potential to improve access to high quality care, but these direct-to-consumer sites currently have problems with patient choice, transparency, quality, and care coordination.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Jack S. Resneck, Michael Abrouk, Meredith Steuer, Andrew Tam, Adam Yen, Ivy Lee, Carrie L. Kovarik, Karen E. Edison.
Choice, Transparency, Coordination, and Quality Among Direct-to-Consumer Telemedicine Websites and Apps Treating Skin Disease. JAMA Dermatology, 2016; DOI:10.1001/jamadermatol.2016.1774

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