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Telemedicine Found to Expand Care to Less Engaged Patients

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4 February 2014. A study by Rand Corporation, a policy analysis organization, indicates people who use a service that makes possible medical help from a doctor over the telephone tend to be those without established health care relationships. The findings of Rand policy analysts Lori Uscher-Pines and Ateev Mehrotra appear in the February 2014 issue of the journal Health Affairs (paid subscription required).

Projected increases in health care from the expansion of insurance coverage and Medicaid under the Affordable Care Act are focusing more attention on use of telephone and Internet-based services to relieve the expected additional workloads on primary care providers. “However, little is known about how these services are being used and whether they provide good quality care,” says Uscher-Pines in a Rand statement. “Our study provides a first step to better understand this growing health care trend.”

Uscher-Pines and Mehrotra analyzed insurance claims data from April 2012 to February 2013 that covered 3,701 patient encounters with Teladoc, a service providing telephone and online video visits with a physician. Before calling a doctor, patients first must establish Teladoc accounts and provide their medical histories.

Once in the Teladoc system, subscribers call for telephone or video consultation, which can result in a diagnosis, recommendation for further tests, or a prescription. Teladoc says its average call-back time is 16 minutes; the authors say call-backs usually occur in 20 to 25 minutes.

In the Rand study, the patient records examined were those covered by the California Public Employees’ Retirement System, which provides health insurance to the state’s public workers. The authors compared adults using Teladoc to counterparts who visited hospital emergency rooms or doctors’ offices for similar conditions.

Uscher-Pines and Mehrotra found the most common complaints for which people contacted Teladoc were acute respiratory conditions, urinary tract infections, and skin problems that comprised about half of the cases reviewed. In addition, more than one-third of Teladoc visits take place on weekends or holidays. Compared to people going to their own doctors or emergency rooms, Teladoc users are younger, more affluent, and less likely to have used health care before the introduction of Teladoc.

However, this lack of previous engagement with health care providers could have a down side. Teladoc users are also less likely to have follow-up visits in any setting, compared to patients visiting doctors’ offices or emergency rooms, but the authors indicate the fewer follow-up encounters may be due to resolution of the patients’ problems during the Teladoc calls.

Uscher-Pines and Mehrotra also note that quality and safety issues still need to be addressed, given that Teladoc physicians do not have the benefit of in-person examinations or diagnostics, as well as overall cost of care when using telemedicine services.

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