Researchers: Telehealth companies could benefit from attention to detail on antibiotics use, other services

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Researchers from RAND and Harvard Medical School believe their look into the use of Teladoc by members of the California Public Employees' Retirement System (CalPERS) could help to improve services offered in the future by direct-to-consumer (DTC) telemedicine companies.

In a study published in the April edition of Telemedicine and e-Health, researchers examined claims from all CalPERS enrollees between 18 and 64 years of age from April 2012 and October 2013; in particular, they compared Healthcare Effectiveness Data and Information Set (HEDIS) measures of physician office patients with those of Teladoc users. Of the more than 233,900 enrollees offered Teladoc, 3,043 used the service for a total of 4,657 visits.

Among the study authors' findings:

  • Teladoc users were only slightly more likely to be located in rural areas (6 percent vs. 5.8 percent) and in a Health Professional Shortage Area (22.2 percent vs. 20 percent) compared to nonusers. The authors note that simply offering DTC telemedicine "may not be sufficient" since patients "must be somewhat technologically savvy and willing to experiment" with new delivery models. They add that companies like Teladoc should be more aggressive when it comes to marketing and education within patient medical homes.
  • Physician offices performed better than Teladoc on appropriate testing for pharyngitis (an associated strep test was performed in 50 percent of physician visits, but only 3.4 percent of Teladoc visits).
  • Physician offices prescribed antibiotics for acute bronchitis less than Teladoc providers; bronchitis, the researchers point out, is a diagnosis for which antibiotics are "never appropriate."

"DTC telemedicine is growing at a rapid rate despite lack of evidence-based research on whether it is offering care of comparable quality or fulfilling its promise to reach the patients who need it most," the researchers write. "Although additional work is needed to fully explore the impact of DTC telemedicine on access and the extent to which different feature of DTC telemedicine services impact quality, our research suggests that focused attention is needed on the use of antibiotics and on facilitating diagnostic testing."

Teladoc, of course, is in an ongoing battle with the Texas Medical Board over how telemedicine services can be provided in the Lone Star State. In December, a judge for a second time sided with Teladoc in a court battle with the board, which wants to require in-person visits before the use of telemedicine to prescribe medications. In addition, rules proposed in January by the Texas Board of Examiners of Professional Counselors would require licensed professionals to practice in Texas and perform a face-to-face intake session before telehealth counseling.

Kofi Jones, vice president of government affairs for Boston-based telehealth company American Well, says in a recent post to The Health Care Blog that, in addition to the proposed behavioral health rules, the Texas Medical Board is also creating a new call-coverage model to enable telemedicine providers to "leverage after hour and specialty care."

To learn more:
- here's the study abstract
- check out The Health Care Blog post