Zhuo Shi is a research assistant in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.
Ateev Mehrotra is an associate professor in the Department of Health Care Policy, Harvard Medical School.
Health Aff (Millwood). 2018 Dec;37(12):2014-2023. doi: 10.1377/hlthaff.2018.05091.
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.
在直接面向消费者的远程医疗中，医生通过实时视听会议治疗患有急性呼吸道感染等常见疾病的患者。早期的研究对直接面向消费者的远程医疗提供的护理质量的结果喜忧参半，受到样本量小和地理范围狭窄的限制。利用一家大型全国商业保险公司 2015-2016 年的理赔数据，我们对 38839 例直接面向消费者的远程医疗就诊中急性呼吸道感染诊断的成年人的抗生素管理质量进行了研究，将其与 942613 例匹配的初级保健就诊和 186016 例匹配的紧急护理就诊的质量进行了比较。在匹配分析中，我们发现抗生素使用、广谱抗生素使用和符合指南的抗生素管理的临床相似率。然而，直接面向消费者的远程医疗就诊中链球菌检测的适宜性较差，随访就诊的频率较高。这些结果表明，直接面向消费者的远程医疗质量有具体的改进机会。
