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CASE STUDY

Ms. Jones lets out a groan as she wakes up. She feels the familiar pressure/burning sensation she has had with prior urinary tract infections. As someone who is prone to such infections she knows she needs a course of antibiotics. However, she worries how and when she will be able to visit her primary care physician. Although Ms. Jones has a good relationship with her physician, it usually takes a couple of days to get an appointment, and she has to budget for half a day for the drive to the physician's office and the time in the waiting room. Given her already overwhelming schedule of taking care of her children and her work responsibilities, fitting in a visit to her physician seems near impossible.

She then remembers receiving a notice from her health plan that they now cover telemedicine visits. Wondering if this may be a better alternative, Ms. Jones sets up her laptop in the kitchen; clicks her way to the telemedicine company's website; registers with her insurance card; and answers some questions about her past medical history, medications, and allergies. Ten minutes later a physician appears on her laptop's screen and asks Ms. Jones about her history and symptoms. He diagnoses Ms. Jones with a urinary tract infection and sends an antibiotic prescription to the local pharmacy.

After the visit is over, Ms. Jones marvels at the convenience and how much time it saved her. However, she cannot help but wonder whether she received high-quality care.

Both existing health systems and private companies such as Teladoc, American Well, and Doctor on Demand now offer patients around-the-clock “virtual” access to physicians for minor illnesses, rashes, or behavioral health issues. Patients can access these visits via telephone or videoconferencing on their smartphone, tablet, or laptop. On demand access to healthcare providers through personal devices represents a new type of telemedicine, direct-to consumer (DTC) telemedicine. DTC telemedicine may be the most popular form of telehealth: there were a reported 1.25 million DTC telemedicine visits in 2015 1 ; and Teladoc alone recently reported in that in 2016 it provided over 950,000 visits, a 65% increase from 2015. 2 A recent survey of large employers indicated that 74% planned to offer a DTC telehealth option to their employees in 2016. 3 In this chapter we explore the rising popularity of DTC telemedicine, some of its unique features, and research on the quality and costs of the care provided.

HOW IS DTC TELEMEDICINE DIFFERENT FROM OTHER FORMS OF TELEHEALTH?

As suggested by its name, DTC telemedicine is distinct from other forms of telehealth in that the patient initiates the care. In most other forms of telehealth, a clinician initiates the visit. For example, if a patient arrives in an emergency department with strokelike symptoms, the emergency department physician initiates the telestroke system. Similarly, if a patient with schizophrenia needs specialty input from a psychiatrist, ...

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