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DTC Telemedicine: Risk or Relief?

Most talk of telemedicine centers around doctor’s offices, medical facilities, and hospitals, but another segment is drawing increased attention—and unease. Direct-to-consumer telemedicine, in which a telemedicine company links a health care provider with a patient upon the patient’s request, perhaps through a smartphone app or in a supermarket with a private kiosk, has been rising in popularity due to the clear benefits offered by the modality. However, a recent editorial in JAMA brings up serious concerns about the quality of care being provided to these patients via DTC telemedicine.

DTC telemedicine has long been lauded for its convenience to patients and its ability to increase access to care for individuals with limited mobility and for those in remote areas. On the clinician’s side, telemedicine allows him/her to see more patients, more efficiently each day. Traditionally, when a consumer initiates a DTC interaction, he/she is connected to a clinician through a real-time video conference call that mimics an in-office visit.

Lately, though, a new model for DTC telemedicine has emerged: Upon initiating a telemedicine visit, the patient selects either a suspected medical condition or a desired prescription. Then, he/she fills out a medical questionnaire to be evaluated by a clinician. The clinician will contact the patient later by messaging, telephone call, or video call only if there is a possible contraindication for that patient. Otherwise, the requested prescription is sent to a local pharmacy or mailed directly to the patient—sold by the telemedicine company itself.

At first glance, this strategy looks like a big time-saver; if written comprehensively, the questionnaire can reduce the time needed by the clinician to gather medical history and symptoms. In addition, this approach encourages patients to take a more active role in managing their health and monitoring their medications.

Unfortunately, this method shifts the focus from finding the best care option for the patient’s medical problem to screening for patients who cannot take the medication they want. In effect, the clinician may still be diagnosing the condition—if the questionnaire is written and answered well—but the treatment plan is being designed by the patient rather than the person with the specialized medical training. This process eliminates the two-way discussion between patient and provider in which both, as a team, explore all care options and develop the best treatment plan for the patient’s particular situation.

In addition, while trying to increase their customer base, DTC companies’ advertising may sensationalize normal conditions as disease states, leading consumers to seek unnecessary treatments. For instance, since many symptoms are similar, situational anxiety may be mistaken as a long-term medical condition caused by chemical imbalances in the body.

Due to these concerns, some are questioning the validity of DTC telemedicine visits: Is the quality of care received equivalent to that of an in-office visit? Critics cite the narrow focus, incomprehensive questionnaires, and lack of an in-person physical examination or diagnostic testing as hindrances to delivering the best care possible to patients.

At this point, it appears that DTC telemedicine is here to stay. Only a few medical conditions or medications are permitted to be addressed through this newest approach, but telemedicine companies are clamoring to expand their line of services. As this industry segment continues to grow, it behooves us to monitor the new treatment options to make sure that quality of care remains preserved alongside convenience.

To read the JAMA editorial, visit JAMA Network here.

To read an analysis of the JAMA editorial, visit MobiHealthNews here.

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