The limits of DTC telehealth

Telehealth holds the promise of increasing access to care. But research findings concerning direct-to-consumer (DTC) telehealth, reported in JAMA Network Open last month, suggest that it might not be as simple as that.

Ateev Mehrotra, M.D., M.P.H., an associate professor of health policy and medicine at Harvard Medical School and a member of Managed Healthcare Executive®’s editorial advisory board, and Tara Jain, M.D., MBA, a physician at Brigham and Women’s Hospital in Boston, conducted a cross-sectional study of telehealth usage by using de-
identified data from a DTC telehealth company (they don’t name the company). The company’s services were available in 20 states, and the data Mehrotra and Jain used in the analysis were for about 35,000 visits between Oct. 1, 2019, and Dec. 31, 2019. Comparing the telehealth users with the overall population in those states, the researchers found that the telehealth patients were more likely to live in urban areas and high-income ZIP codes. Only 14.4% of the visits
were for patients living in areas identified as having a shortage
of primary care.

When Mehrotra and Jain looked at why people used the company’s services, they found that 87% of the visits were for one of three conditions: urinary tract infections (53%), erectile dysfunction (21%) and contraception (13%).

Mehrotra and Jain put barriers to access into different categories and suggest that their findings indicate that DTC telehealth helps with some barriers (accommodation barriers having to do with convenience and acceptability barriers having to do with embarrassment about sexual issues) but not others (clinician availability or affordability barriers). “Those seem like important barriers, and telehealth isn’t addressing them,” Mehrotra said.

But Mehrotra also stressed that “telehealth” is an umbrella term: “DTC is just one distinct form of telehealth,” he said. “In this application, the advantage was the convenience and avoidance of embarrassment. I think that is an important finding, but there are many other forms of telehealth.”