JMIR Publications

ABSTRACT

Background:

Telemedicine is expanding rapidly, with public Direct-to-consumer (DTC) telemedicine representing 70% of the market. A key priority is to establish clear distinctions in quality between the public and private sectors. There were no studies directly comparing public and private sectors quality of DTC telemedicine using methods of objective evaluation.

Objective:

This study using a standardized patient (SPs) approach aims to compare the quality of the DTC telemedicine provided by public and private sectors in China.

Methods:

We recruited ten standardized patients presenting fixed cases (Urticaria and Childhood diarrhea), including 594 interactions between physicians and standardized patients. Various aspects of the quality of care, effectiveness, safety, patient-centredness, efficiency and timeliness, were evaluated by the SPs with the IOM quality framework. Ordinary least-squares regression models with fixed effects were used for the continuous variables and logistic regression models with fixed effects were used for the categorical variables.

Results:

Significant quality differences were observed between public and private DTC telemedicine. Physicians from the private platforms were significantly more likely to adhere to the checklist (adjusted β 15.36, 95% CI 12.53~18.20), provide accurate diagnoses (adjusted OR 3.86, 95% CI 1.79~8.35), appropriate prescriptions (adjusted OR 3.87, 95% CI 2.04~7.34), and lifestyle modification advice (adjusted OR 6.94, 95% CI 3.17~15.17), communicate more patient-centered (adjusted β 3.36, 95% CI 2.48~4.24), and response more times (adjusted β 1.34, 95% CI 0.92~1.75) and words (adjusted β 53.19, 95% CI 7.22~99.16). But SPs in the private platforms waited longer for the first response (adjusted β 8.54, 95% CI 4.36~12.72) and paid more for the visit (adjusted β 39.80, 95% CI 31.81~47.78).

Conclusions:

There was significant quality inequality in different DTC telemedicine platforms. Private physicians might provide a higher quality of service in terms of effectiveness and safety, patient-centeredness, and times and words of providers’ responses. However, private platforms experienced longer wait time for their first response and incurred higher costs. Refining online reviews, establishing standardized norms and pricing, enhancing the performance evaluation mechanism for public DTC telemedicine, and imposing stricter limitations on first response time for private physicians should be considered effective approaches towards optimizing the management of DTC telemedicine.