O0002 Oct.4: 3:15pm - Patterns of Use and Correlates of Satisfaction for a Large Nationwide Direct-to-Consumer Telemedicine Service for Pediatric Patients

Background: Consumers are increasingly accessing direct-to-consumer virtual platforms for their healthcare needs, but there is a dearth of data describing use for pediatric patients. We describe use and correlates of satisfaction for a large telemedicine service currently operating in the United States.

Methods: In June 2015, the Cleveland Clinic contracted to use a leading nationally available telemedicine platform. As part of the data-use agreement, the vendor agreed to provide data from their Online Care Group (OCG), a physician owned and operated telehealth practice. The OCG will address minor, medical problems through encrypted synchronous video, audio and text. Patients, or their representatives, can access the service from all 50 states, 24-hours a day. Data was provided for all encounters from July 2016 through July 2018.

The most frequent encounter diagnoses codes were identified via the visit International Classification of Diseases, 10th Revision code entered by the provider. Geographic location was determined by patient-reported, or provider located US state, and grouped into census-defined regions.

Prescription receipt was determined by the presence of a National Drug Code associated with the encounter. At encounter conclusion, participants were prompted to rate satisfaction with their telemedicine physician on a Likert scale from 0 to 5 stars. Because satisfaction data are highly skewed, we dichotomized responses as 5-stars vs less than 5-stars, in accordance with Medicare guidelines.

Using mixed effects logistic regression, accounting for clustering by physician, we analyzed differences in patient satisfaction scores and factors associated with receiving a prescription.

Results: Of the 36,610 encounters by 786 providers, the majority of encounters were for respiratory tract ailments (33.4%), dermatologic concerns (13.1%), conjunctivitis (12.5%) or sinusitis (10.7%). Most patients received a prescription (65.2%), rated their provider highly (91.7%), and would have sought care at an urgent care center (30.3%) or doctor’s office (24.0%) (Table 1). Factors which were most associated with satisfaction were the receipt of a prescription (odds ratio [OR] 2.29; 95% confidence interval [CI] 2.09 to 2.51), or seeing a Pediatrician vs a Family Medicine (OR 0.62; 95% CI 0.44 to 0.87), Emergency Medicine (OR 0.64; 95% CI 0.50 to 0.82), or Internal Medicine (OR 0.53; CI 0.38 to 0.75). Older patients were more likely to receive, and Pediatricians were less likely to provide a prescription (Table 2).

Conclusion: Pediatric patients are obtaining care via virtual health services primarily for acute respiratory conditions and virtual care appears primarily to serve as a substitute for care provided at doctor’s offices or urgent care. While Pediatricians prescribed at a lower rate than their colleagues, their satisfaction scores were higher. As providers provide more care via virtual platforms, further work should be directed toward a better understanding how virtual services fit into the overall healthcare landscape.