Use of Commercial Direct-to-Consumer Telemedicine by Children

In commercial direct-to-consumer (DTC) telemedicine, physicians outside of the medical home treat common, acute complaints through real-time, audio-visual conferencing using telephones and personal computers. There has been little examination of the use of DTC telemedicine by children. We describe trends in DTC telemedicine use and DTC telemedicine visit characteristics.

Using 2011-2016 claims from a large national health plan, we identified pediatric acute visits to DTC telemedicine and to primary care providers (PCPs). We examined DTC telemedicine visit trends and compared DTC telemedicine and acute PCP visit diagnoses and patient characteristics.

From 2011 through 2016, pediatric DTC telemedicine visits increased from 38 to 24,409 visits annually. In 2015 and 2016, the most common primary diagnoses for DTC telemedicine visits (n = 42,072) were infections of the nose/sinuses (24%), mouth/throat (16%), and ear (9%), which were also the most common diagnoses for acute PCP visits (n = 6,917,976). Odds of DTC telemedicine use were higher for children in non-metropolitan communities (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.40-1.51) and children without preventive visits (OR, 1.08; 95% CI, 1.06-1.11). Compared to children receiving acute PCP care, children with DTC telemedicine visits were also more likely to have had urgent care (17% vs 10%; P < .001) and emergency department visits (21% vs 19%; P < .001) during the study period.

The use of commercial DTC telemedicine visits for children is growing rapidly, primarily for acute respiratory infections. Compared to children who did not use DTC telemedicine for acute care, children using DTC telemedicine were also more likely to use other venues for acute care outside of the medical home.