Patterns of Use and Correlates of Patient Satisfaction with a Large Nationwide Direct to Consumer Telemedicine Service

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Abstract

<div class="section"> <a class="named-anchor" id="d450014e241">  </a> <h5 class="section-title" id="d450014e242">Background</h5> <p id="Par1">Despite its rapid expansion, little is known about use of direct to consumer (DTC) telemedicine. </p> </div><div class="section"> <a class="named-anchor" id="d450014e246">  </a> <h5 class="section-title" id="d450014e247">Objective</h5> <p id="Par2">To characterize telemedicine patients and physicians and correlates of patient satisfaction</p> </div><div class="section"> <a class="named-anchor" id="d450014e251">  </a> <h5 class="section-title" id="d450014e252">Design</h5> <p id="Par3">Cross-sectional study</p> </div><div class="section"> <a class="named-anchor" id="d450014e256">  </a> <h5 class="section-title" id="d450014e257">Participants</h5> <p id="Par4">Patients and physicians of a large nationwide DTC telemedicine service</p> </div><div class="section"> <a class="named-anchor" id="d450014e261">  </a> <h5 class="section-title" id="d450014e262">Main Measures</h5> <p id="Par5">Patient characteristics included demographics and whether or not they reported insurance information. Physician characteristics included specialty, board certification, and domestic versus international medical training. Encounter characteristics included time of day, wait time, length, coupon use for free or reduced-cost care, diagnostic outcome, prescription receipt, and patient/physician geographic concordance. Patients rated satisfaction with physicians on scales of 0 to 5 stars and reported where they would have sought care had they not used telemedicine. Logistic regression was used to assess factors associated with 5-star physician ratings. </p> </div><div class="section"> <a class="named-anchor" id="d450014e266">  </a> <h5 class="section-title" id="d450014e267">Key Results</h5> <p id="Par6">The analysis included 28,222 encounters between 24,040 patients and 277 physicians completed between January 2013 and August 2016. Sixty-five percent of patients were under 40 years and 32% did not report insurance information. Family medicine was the most common physician specialty (47%) and 16% trained at a non-US medical school. Coupons were used in 24% of encounters. Respiratory infections were diagnosed in 35% of encounters and 69% resulted in a prescription. Had they not used telemedicine, 43% of patients reported they would have used urgent care/retail clinic, 29% would have gone to the doctor’s office, 15% would have done nothing, and 6% would have gone to the emergency department. Eighty-five percent of patients rated their physician 5 stars. High satisfaction was positively correlated with prescription receipt (OR 2.98; 95%CI 2.74–3.23) and coupon use (OR 1.47; 95%CI 1.33–1.62). </p> </div><div class="section"> <a class="named-anchor" id="d450014e271">  </a> <h5 class="section-title" id="d450014e272">Conclusions</h5> <p id="Par7">Patients were largely satisfied with DTC telemedicine, yet satisfaction varied by coupon use and prescription receipt. The impact of telemedicine on primary care and emergency department use is likely to be small under present usage patterns. </p> </div>

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Yunjie Song, Jonathan Skinner, Julie Bynum … (2010)

Current methods of risk adjustment rely on diagnoses recorded in clinical and administrative records. Differences among providers in diagnostic practices could lead to bias. We used Medicare claims data from 1999 through 2006 to measure trends in diagnostic practices for Medicare beneficiaries. Regions were grouped into five quintiles according to the intensity of hospital and physician services that beneficiaries in the region received. We compared trends with respect to diagnoses, laboratory testing, imaging, and the assignment of Hierarchical Condition Categories (HCCs) among beneficiaries who moved to regions with a higher or lower intensity of practice. Beneficiaries within each quintile who moved during the study period to regions with a higher or lower intensity of practice had similar numbers of diagnoses and similar HCC risk scores (as derived from HCC coding algorithms) before their move. The number of diagnoses and the HCC measures increased as the cohort aged, but they increased to a greater extent among beneficiaries who moved to regions with a higher intensity of practice than among those who moved to regions with the same or lower intensity of practice. For example, among beneficiaries who lived initially in regions in the lowest quintile, there was a greater increase in the average number of diagnoses among those who moved to regions in a higher quintile than among those who moved to regions within the lowest quintile (increase of 100.8%; 95% confidence interval [CI], 89.6 to 112.1; vs. increase of 61.7%; 95% CI, 55.8 to 67.4). Moving to each higher quintile of intensity was associated with an additional 5.9% increase (95% CI, 5.2 to 6.7) in HCC scores, and results were similar with respect to laboratory testing and imaging. Substantial differences in diagnostic practices that are unlikely to be related to patient characteristics are observed across U.S. regions. The use of clinical or claims-based diagnoses in risk adjustment may introduce important biases in comparative-effectiveness studies, public reporting, and payment reforms. 2010 Massachusetts Medical Society