Only a small percentage of older Americans have jumped on the growing trend of getting health care services and prescriptions directly from an online-only company, rather than seeing regular health care providers in person or via telehealth, according to a new poll.
But that could change quickly, the University of Michigan research suggests.
Overall, 7.5% of people between the ages of 50 and 80 have used at least one direct-to-consumer health care service from an online-only provider, according to new findings from the National Survey on Healthy Aging (https://www.healthyagingpoll.org/).
Of those who used such a service, most said they were driven by convenience. More than 60% of them received a prescription, mostly for a one-time treatment. But only a third of them informed their regular health care provider about the prescription.
People in pre-Medicare years 50 to 64 were more than twice as likely as adults over 65 to have used direct-to-consumer or DTC online health services (10% vs. 4%). Meanwhile, 47% of over-65s said they had never heard of such companies.
Looking ahead, nearly a third of all older adults and more than 42% of those ages 50 to 64 said they would be interested in using such services in the future.
The poll is based at the UM Institute for Healthcare Policy and Innovation and is supported by AARP and Michigan Medicine, UM’s academic medical center.
For the DTC survey, the survey team worked with members of UM’s Center for Value-Based Insurance Design, who are interested in how cost and convenience affect people’s health care decisions and the continuum of care.
A rapidly growing sector is causing concern
The rise of DTC websites and subscription-based apps that promise convenient online access to providers who can assess symptoms, make diagnoses and prescribe medications has received a lot of attention, especially amid a national crisis in the availability of primary care providers and on time appointment.
Such companies include Amazon Clinic, Sesame, Roman, BetterHelp, Rosy, Lemonaid, Hims & Hers and do not require a referral or health insurance. Drug companies and membership-based organizations, including Weight Watchers and Costco, have also begun to offer access to such direct services.
However, the trend has raised concern because of the potential for patients to receive care and prescriptions from providers who do not know their full health history, do not have access to their complete medical records, and may not screen for potentially dangerous drug interactions.
A third of those who had used a DTC service said their primary care provider did not know they had. If they received a new prescription through an encounter with a DTC health service, one-third said their regular primary care provider was not informed of the new drug they were prescribed. The majority of those who received prescriptions through a DTC service said they were for one-time treatment.
“These exciting findings have important implications for patient safety and continuity of care,” said Mark Fendrick, MD, director of the VBID and IHPI member, who is a primary care physician at Michigan Medicine. “With rapid growth in this area of healthcare predicted for this year and beyond, all providers, insurers and regulators must pay closer attention to how patients use these services and why, as well as the impact on quality and safety of care”. Fendrick is a professor of internal medicine in the Department of General Medicine at the UM School of Medicine.
His colleague Nicole Hadeed, MD, who also worked on the poll and is a clinical assistant professor, notes that while the number of survey participants who said they had used DTC services was relatively small, the analysis provides clues that should provide information for further research.
Types of care received
Almost half of those who had used a DTC service said it was for general health care such as treating allergies, sinus infections, pink eye or acid reflux, although again there was a clear difference between the 50-64 and 65-80 age groups.
Overall, nearly 12% said they had used a service for mental health reasons, but the percentage was much higher (50%) among respondents who said they rated their mental health as fair or poor and had used a DTC service of any kind.
In terms of other types of care, 15% had sought help from a DTC service for a sexual health issue, 9% had used it for skin care, 6% had used it for weight management, almost 5% had used it for hair loss and A similar percentage had used it for pain management.
Convenience topped the list of reasons for choosing a DTC service, with 55% saying it drove their decision. However, lack of access to regular health care provider, lack of regular health care provision, or needing a service when their health provider was not open or available was reported by approximately 20%. Discomfort discussing a sensitive health topic with a provider — often cited in marketing by such companies — was reported by only 10% of those who had turned to a DTC service.
“For both patients and providers, these findings drive home the importance of open dialogue and transparency about the potential uses, benefits, and risks of these services — and the importance of maintaining contact for ongoing primary care.” said Jeffrey Kullgren, MD, MPH. , MS, director of the poll and primary care provider at the VA Ann Arbor Healthcare System, who is also an associate professor at the School of Medicine.
More than 55% of survey respondents who had used a direct-to-consumer service said the overall quality of care they received from their primary care provider was better than they received from a DTC provider.
Fendrick and Hadeed wrote about the potential long-term change in primary care use of telehealth services in an article published early in the COVID-19 pandemic in American Journal of Managed Care.
And in fact, 58% of survey respondents who had used a DTC service had started doing so in 2020, 2021 or 2022.
The rapid shift during the pandemic to vaccinating in pharmacies, rather than just primary care clinics, has also changed the way people think about alternative ways of providing care that may be closer to home or have more flexible hours .
However, Fendrick notes, pharmacies share vaccination information with insurance companies and statewide vaccination registries that primary care providers can access.
“Patients will increasingly seek online care because of the convenience it can provide, especially for those willing to pay out-of-pocket costs,” Fendrick said. “Its use will likely be boosted by the rapidly growing number of online sellers and the national shortage of primary care physicians. The recent launch of a telemedicine platform that offers home delivery of the new wildly popular weight loss drugs is a notable example of this trend.”
He added, “Given the potential expansion of online care, it is important that people inform their regular clinician and that we as providers consistently ask our patients about their use. medications they take, it should become standard practice for me to ask about prescriptions or diagnoses they’ve received online, as it may affect their care.”
The poll was a nationally representative survey conducted by NORC at the University of Chicago for the IHPI and administered online and by telephone in July and August 2023 to 2,657 adults aged 50 to 80 years. In total, 168 respondents reported having used a DTC health care service. The sample was then weighted to reflect the US population. Read previous National Poll on Healthy Aging reports (https://www.healthyagingpoll.org/reports-more) and about the poll methodology (https://www.healthyagingpoll.org/survey-methods).