Influenza Management via Direct to Consumer Telemedicine: an Observational Study
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J Gen Intern Med DOI: 10.1007/s11606-020-05640-5 © Society of General Internal Medicine 2020
BACKGROUND
Oseltamivir can shorten duration of influenza symptoms, but only if administered within 48 h.1 In primary care, only 20% of patients receive oseltamivir, due to false negative tests and patients presenting too late.2 By connecting patients with physicians 24 h a day, direct to consumer (DTC) telemedicine could solve these problems, without exposing others to infection. Whether DTC telemedicine improves treatment rates or treatment appropriateness is unknown.
OBJECTIVE
Of all influenza diagnoses (n = 8055), 88% were during epidemics. Following diagnosis, oseltamivir prescription did not vary by epidemic status (80% during epidemics versus 78% during non-epidemics, p = 0.157). Table 1 describes sample characteristics and associations with diagnosis and treatment. Thirty-five percent of patients seeking care for influenza received it during weekends or after hours. Median wait time was 4.6 min (interquartile range (IQR) 1.9– 10.3) and median visit length was 4.9 min (IQR 3.5– 7.4). Had they not used telemedicine, 87% said they would have gone to a doctor’s office, urgent care, or the emergency room. Among patients seeking care for influenza, calling during an epidemic was strongly associated with oseltamivir prescription (aOR 7.78; 95% CI 6.86–9.27) (Table 2), while not reporting insurance was negatively associated (aOR 0.68; 95% CI 0.57–0.82).
The objective of this study was to characterize care seeking, diagnosis, and treatment for influenza in a large DTC telemedicine service. DISCUSSION METHODS AND FINDINGS
We describe encounters from a nationwide telemedicine platform,3 conducted between July 2016 and August 2018. Patients stated their call reason using free text and provided age, gender, and insurance information. To assess appropriateness, we described patterns of care by epidemic status and assessed patient, physician, and encounter characteristics associated with an influenza diagnosis and oseltamivir prescription. Epidemics were identified using the Center for Disease Control’s Weekly U.S. Influenza Map,4 with encounters categorized as occurring during an epidemic or not. Oseltamivir prescriptions were identified via National Drug Codes. Using mixed effects logistic regression, we estimated the odds of oseltamivir prescription among patients seeking care for influenza, accounting for clustering by physician. During the study period, 8112 patients called for “influenza.” Of these, 3104 (38%) received an influenza diagnosis (53% during epidemics versus 11% during non-epidemics). Received October 8, 2019 Revised November 19, 2019 Accepted January 3, 2020
In this observational study of DTC telemedicine, patients frequently sought care for influenza and most diagnoses were made during epidemics. Early diagnosis is important both for treatment and to avoid spread of infection. During an epidemic, diagnosis can be made based on symptoms alone.5, 6 Rapid testing is not required and has a false negative rate
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