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      Direct-to-Consumer Virtual Urgent Care: A Descriptive Study and Outline for Common Practice Management Decisions


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          Direct-to-consumer (DTC) virtual urgent care (VUC) visits are increasingly popular across both for-profit and nonprofit healthcare systems; however, few peer-reviewed studies have described the ecology of a VUC program.


          In this retrospective cohort study, patients ( N = 2,216) received care through a VUC platform offered by a regional health system over an approximately 2-year period.


          Seventy-one percent of patients were identified as females. The age of the patients ranged from 18 to 85 years (median 39 years, interquartile range [IQR] 32–49 years). Eighty-four percent ( n = 1,906) of patients had a registered primary care provider (PCP), while 177 (8%) chose to self-pay for the VUC service. Seventy-six percent of visits occurred between Monday and Friday, and 71% ( n = 1,573) visits occurred between 8 am and 6 pm. The median provider response time was 24 minutes. Visits were conducted by videoconference 84% of the time; providers and patients spent a median of 7.4 minutes (IQR 4.3, 9.9 min) together in the video room. Seventy-seven percent of visits generated a prescription, of which 70% were on antibiotics.


          Most virtual visits were initiated by existing health system patients with a primary care physician, and the majority of patients sought care during usual business hours. Most visits led to a prescription, most commonly an antibiotic. These data can help inform operational leaders who are considering how best to structure, staff, and develop key performance indicators for their own VUC programs. Additionally, these data challenge the notion that acute, episodic DTC encounters occur after-hours and are utilized by uninsured patients who lack a relationship with a primary care physician.

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          Most cited references12

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          Trends in Telemedicine Use in a Large Commercially Insured Population, 2005-2017

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            Disparities in enrollment and use of an electronic patient portal.

            With emphasis on the meaningful use of electronic health records, patient portals are likely to become increasingly important. Little is known about patient enrollment in, and use of, patient portals after explicit invitation from providers. To examine enrollment in, and use of, an electronic patient portal by race/ethnicity, gender and age. Observational, cross sectional study. Patients with attending physicians seen at one urban, academic primary care practice between May 2008 and October 2009 who received electronic orders inviting their participation in an electronic patient portal. (a) Enrollment in the patient portal, (b) Solicitation of provider advice among enrollees, (c) Requests for medication refills among enrollees. Overall, 69% of 7,088 patients enrolled in the patient portal. All minority patients were significantly less likely to enroll than whites: 55% blacks, 64% Latinos and 66% Asians compared with 74% whites (chi-square p < 0.05 for all pairwise comparisons). These disparities persisted in adjusted analyses, although differences for Asians were no longer significant. In addition, the oldest patients were less likely to enroll than the youngest (adjusted OR 0.79, 95% CI 0.65-0.97). Although there were no racial/ethnic disparities in use of the patient portal among enrollees, we found differences by age and gender. The youngest patients were significantly less likely to solicit provider advice or request medication refills than any other age group in unadjusted and adjusted analyses. Similarly, male patients were less likely to solicit provider advice than women in all analyses. Large racial/ethnic disparities were seen in enrollment in our patient portal. Among enrollees, use of the portal was similar by race/ethnicity, but not by age or gender. Future efforts to expand use of the patient portal need to address potential mechanisms for these disparities to ensure this technology is accessible to diverse patient populations.
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              Access and Quality of Care in Direct-to-Consumer Telemedicine.

              Direct-to-consumer (DTC) telemedicine serves millions of patients; however, there is limited research on the care provided. This study compared the quality of care at Teladoc ( www.teladoc.com ), a large DTC telemedicine company, with that at physician offices and compared access to care for Teladoc users and nonusers.

                Author and article information

                Telehealth and Medicine Today
                Partners in Digital Health
                26 June 2019
                : 4
                : 10.30953/tmt.v4.154
                [0001]Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
                Author notes
                Corresponding Author: Christopher B. Davis, christopher.davis@ 123456ucdenver.edu
                © 2019 Christopher B. Davis

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, adapt, enhance this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                Research and Innovation

                Social & Information networks,General medicine,General life sciences,Health & Social care,Public health,Hardware architecture
                Virtual urgent care,Telemedicine,Direct-to-consumer


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