Access and Quality of Care in Direct-to-Consumer Telemedicine

Uscher‐Pines, Lori; Mulcahy, Andrew W.; Cowling, D. C.; Hunter, Gerald P.; Burns, Rachel M.; Mehrotra, Ateev

doi:10.1089/tmj.2015.0079

Cited by 145 publications

(164 citation statements)

References 7 publications

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“…Substantial concerns have been raised for the potential for such visits to increase inappropriate antimicrobial use. 29–31 Nevertheless; e-visits have advantages over telephone encounters. First, they are structured appointments and telephone-based prescribing is not.…”

Section: Discussionmentioning

confidence: 99%

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

Riedle

Polgreen

Cavanaugh

et al. 2016

Infect. Control Hosp. Epidemiol.

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Objective To investigate the scale of antimicrobial prescribing without a corresponding visit, and to compare the attributes of patients who received antimicrobials with a corresponding visit to those who did not have a visit. Design Retrospective cohort Methods We followed 185,010 Medicare patients for one year after an acute myocardial infarction. For each antimicrobial prescribed, we determined if the patient had an inpatient, outpatient or provider claim in the 7 days prior to the antimicrobial prescription being filled. We compared the proportions of patient characteristics for those prescriptions associated with a visit and without a visit (i.e., phantom prescriptions). We also compared the rates at which different antimicrobials were prescribed without a visit. Results We found that of 356,545 antimicrobial prescriptions, 14.75% had no evidence of a visit in the week prior to the prescription being filled. A higher percentage of patients without a visit were identified as white (p<0.001) and female (p<0.001). Patients without a visit had a higher likelihood of survival and fewer additional cardiac events (AMI, cardiac arrest, stroke, all p<0.001). Among the antimicrobials considered, amoxicillin, penicillin, and agents containing trimethoprim and methenamine were much more likely to be prescribed without a visit. In contrast, levofloxacin, metronidazole, moxifoxacin, vancomycin, and cefdinir were much less likely to be prescribed without a visit. Conclusions Among this cohort of patients with chronic conditions, phantom prescriptions of antimicrobials are relatively common and occurred more frequently among those patients who were relatively healthy.

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Section: Discussionmentioning

confidence: 99%

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

Riedle

Polgreen

Cavanaugh

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…127 Many payers are embracing this technology as a way to provide lower cost care for common problems that might otherwise result in an emergency department (ED) visit. 128 Most of these applications rely solely on video and audio connections with additional software for scheduling, billing, sharing of still-frame images, and documentation.…”

Section: Direct-to-consumer Telemedicinementioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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“…Direct-to-consumer (DTC) telemedicine can provide immediate and convenient access to a care provider that usually costs less than a standard in-person urgent care or emergency room visit [3]. DTC telemedicine has also been shown to increase access to care to those without a primary care provider [4, 5]. …”

Section: Introductionmentioning

confidence: 99%

Patient preferences for direct-to-consumer telemedicine services: a nationwide survey

Welch¹,

Harvey²,

O’Connell³

et al. 2017

BMC Health Serv Res

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BackgroundDirect-to-consumer (DTC) telemedicine providers has the potential to change the traditional patient-physician relationship. Professional medical organizations recommend that telemedicine exist within the medical home. This study aims to understand patients’ preferences and desires for DTC telemedicine.MethodsWe conducted a nationwide survey of 4345 survey respondents demographically balanced to represent the United States adult population. The survey consisted of questions assessing the respondents’ attributes and their willingness and comfortability using telemedicine as well as the importance and desired attributes of a provider providing care via telemedicine.ResultsRelatively few respondents (3.5%) had ever had an online video visit with their care provider. Respondents were more willing to see their own provider via telemedicine than unwilling (52% vs. 25%). Additionally, respondents were less willing to use telemedicine to see a different provider from the same healthcare organization (35%) and were least willing to see a different provider from a different organization (19%). Forty-one percent of respondents felt it was unimportant that their current provider offer telemedicine, and only 15% would consider leaving their current provider to a new provider who offers telemedicine as an option. More than half (56%) of respondents felt it was important to have an established relationship with a provider they’re having a telemedicine visit with. Nearly two-thirds of respondents (60%) felt it was important for a telemedicine provider to have access to their health records.ConclusionsPatients prefer to use telemedicine with their own doctor with whom they have an established relationship.

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Access and Quality of Care in Direct-to-Consumer Telemedicine

Cited by 145 publications

References 7 publications

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

Phantom Prescribing: Examining the Frequency of Antimicrobial Prescriptions Without a Patient Visit

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Patient preferences for direct-to-consumer telemedicine services: a nationwide survey

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