Uscher-Pines Lori, Mulcahy Andrew, Cowling David, Hunter Gerald, Burns Rachel, Mehrotra Ateev
1 RAND Corporation , Arlington, Virginia.
2 California Public Employees' Retirement System , Sacramento, California.
Telemed J E Health. 2016 Apr;22(4):282-7. doi: 10.1089/tmj.2015.0079. Epub 2015 Oct 21.
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.
Claims from all enrollees 18-64 years of age in the California Public Employees' Retirement System health maintenance organization between April 2012 and October 2013 were analyzed. We compared the performance of Teladoc and physician offices on applicable Healthcare Effectiveness Data and Information Set measures. Using geographic information system analyses, we compared Teladoc users and nonusers with respect to rural location and available primary care physicians.
Of enrollees offered Teladoc (n = 233,915), 3,043 adults had a total of 4,657 Teladoc visits. For the pharyngitis performance measure (ordering strep test), Teladoc performed worse than physician offices (3% versus 50%, p < 0.01). For the back pain measure (not ordering imaging), Teladoc and physician offices had similar performance (88% versus 79%, p = 0.20). For the bronchitis measure (not ordering antibiotics), Teladoc performed worse than physician offices (16.7 versus 27.9%, p < 0.01). In adjusted models, Teladoc users were not more likely to be located within a healthcare professional shortage area (odds ratio = 1.12, p = 0.10) or rural location (odds ratio = 1.0, p = 0.10).
Teladoc providers were less likely to order diagnostic testing and had poorer performance on appropriate antibiotic prescribing for bronchitis. Teladoc users were not preferentially located in underserved communities. Short-term needs include ongoing monitoring of quality and additional marketing and education to increase telemedicine use among underserved patients.
直接面向消费者（DTC）的远程医疗为数百万患者提供服务；然而，关于所提供护理的研究有限。本研究比较了大型DTC远程医疗公司Teladoc（www.teladoc.com）与医生办公室的护理质量，并比较了Teladoc用户和非用户获得护理的情况。
分析了2012年4月至2013年10月期间加利福尼亚州公共雇员退休系统健康维护组织中所有18 - 64岁参保人的理赔数据。我们比较了Teladoc和医生办公室在适用的医疗保健有效性数据和信息集指标方面的表现。使用地理信息系统分析，我们比较了Teladoc用户和非用户在农村地区位置和可用初级保健医生方面的情况。
在提供了Teladoc服务的参保人（n = 233,915）中，3,043名成年人共进行了4,657次Teladoc就诊。对于咽炎性能指标（开具链球菌检测），Teladoc的表现比医生办公室差（3%对50%，p < 0.01）。对于背痛指标（不开具影像学检查），Teladoc和医生办公室的表现相似（88%对79%，p = 0.20）。对于支气管炎指标（不开具抗生素），Teladoc的表现比医生办公室差（16.7%对27.9%，p < 0.01）。在调整模型中，Teladoc用户位于医疗专业人员短缺地区的可能性并不更高（优势比 = 1.12，p = 0.10），也不在农村地区的可能性也不更高（优势比 = 1.0，p = 0.10）。
Teladoc的提供者开具诊断检测的可能性较小，并且在支气管炎适当抗生素处方方面表现较差。Teladoc用户并非优先位于服务不足的社区。短期需求包括持续监测质量以及进行额外的营销和教育，以增加服务不足患者对远程医疗的使用。
