Quality Of Care For Acute Respiratory Infections During Direct-To-Consumer Telemedicine Visits For Adults

Abstract

In direct-to-consumer telemedicine, physicians treat patients through real-time audiovisual conferencing for common conditions such as acute respiratory infections. Early studies had mixed findings on the quality of care provided during direct-to-consumer telemedicine and were limited by small sample sizes and narrow geographic scopes. Using claims data for 2015-16 from a large national commercial insurer, we examined the quality of antibiotic management in adults with acute respiratory infection diagnoses at 38,839 direct-to-consumer telemedicine visits, compared to the quality at 942,613 matched primary care visits and 186,016 matched urgent care visits. In the matched analyses, we found clinically similar rates of antibiotic use, broad-spectrum antibiotic use, and guideline-concordant antibiotic management. However, direct-to-consumer telemedicine visits had less appropriate streptococcal testing and a higher frequency of follow-up visits. These results suggest specific opportunities for improvement in direct-to-consumer telemedicine quality.

Exhibit 4:. Follow-up Visit Rate across DTC Telemedicine, Primary Care Providers, and Urgent Care in the Matched Sample, 2015–2016

Source: Authors’ analysis of data from 2015-2016 claims from a large national insurer. Notes: Abbreviations: DTC, direct to consumer; PCP, primary care provider. Hypothesis testing performed using chi-square tests, comparing DTC telemedicine visits to PCP visits and to urgent care visits. All comparisons have a p value that is <0.001.