Telemedicine Effective, But Could Fragment Care

The primary care physician shortage has increased interested in telemedicine and users of the service are more likely to be young, affluent and have no established health care relationships.

Telemedicine programs are more likely to be used by patients who are younger and more affluent, according to a new study.

The RAND Corporation study found that patients with no established health care relationships are also more likely to use telemedicine programs to get medical help by talking to a physician on the phone.

RAND researchers Lori Uscher-Pines and Ateev Mehrotra, MD, found little evidence of misdiagnosis of treatment failure among the 3,701 patient “visits” studied using this service. More than half of the problems were acute respiratory conditions, urinary tract infections and skin problems. Other frequent reasons for a telemedicine visit were abdominal pain, back and joint problems, viral illnesses, eye problems and ear infections.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” Uscher-Pines, lead author of the study and a policy researcher at RAND, said in a statement. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing health care trend.”

The primary care physician shortage has increased interested in telemedicine, touted as an alternative way to provide primary care without expanding the number of doctors.

The patients studied were covered through California Public Employees’ Retirement System, which provides health insurance to the state’s public workers. The telemedicine visits accounted for a small proportion of the health care used by this group and more than a third of the telemedicine visits were on weekends or holidays.

The telemedicine users in this study were younger with fewer chronic conditions and were less likely to have used health care in the prior year. They were also slightly more likely to be women and live in more affluent areas.

“The people who are attracted to this type of telemedicine may be a more technologically savvy group that has less time to obtain medical care through traditional settings,” Mehrotra, a RAND researcher and an associate professor at the Harvard Medical School, said in a statement.

Mehrotra and Uscher-Pines noted that more research is necessary to assess the quality and safety of telemedicine services, while RAND points out the concern that expanding telemedicine may lead to a fragmentation of care.