Study: Direct-to-Consumer Telehealth Docs Prescribing "Inappropriately"

Providers treating patients through direct-to-consumer telehealth services were more likely to prescribe costly, antibiotic resistance medication than in-person doctors, according to the recent findings of a research study.

The RAND Corporation, a Santa Monica, Calif.-based nonprofit organization, compared  antibiotic prescribing rates for acute respiratory infection between Teladoc, a direct-to-consumer telemedicine company, and physician offices.

What they found was physicians in both settings were prescribing the same amount of antibiotics, however, direct-to-consumer telehealth doctors had higher rates of "inappropriate" prescribing for bronchitis and other respiratory conditions. 

Specifically, the telehealth doctors were prescribing broad-spectrum antibiotics at a higher rate. Ninety-four percent of Teladoc physicians prescribed broad-spectrum antibiotics for bronchitis, compared to 76 percent of in-person physicians. For sinusitis, it was a 85 percent of Teladoc physicians and 50 percent of in-person physicians. Broad-spectrum antibiotic prescriptions are costlier and contribute to antibiotic resistance, the researchers say. They expressed concern that the higher use of broad-spectrum antibiotics by the telemedicine doctors may be a result of direct-to-consumer companies practicing conservatively, based upon limited diagnostic information about their patients.

“The pattern of treatment offered to patients who saw a physician face-to-face versus those who spoke with a physician on the telephone was not substantially different,” states Lori Usher-Pines, the study’s lead author and a policy researcher at RAND, a nonprofit research organization. “However, we found the antibiotics prescribed during telemedicine ‘visits’ raised some specific quality concerns that require further attention.”

Direct-to-consumer telehealth companies are on the rise, thanks to the convenience they offer and a shortage of primary-care physicians. However, RAND researchers are concerned with the lack of studies that been conducted on the effectiveness of the care they provide.

The research was published in JAMA Internal Medicine.