Chat with a Doctor: Using Asynchronous Virtual Care Access for On-Demand Physician Advice

Direct-to-consumer (DTC) or on-demand telehealth describes a patient-initiated medical encounter using technology in real time—mostly related to acute care or urgent complaints. Initially created and offered by private companies, DTC telehealth is now more ubiquitous, as it has been offered by hospitals, medical centers, multi-specialty practices, and insurers. On-demand telehealth services are implemented in an effort to increase health care access, improve satisfaction and efficiency, as well as drive new revenue. This chapter outlines the types of DTC telehealth, considerations when conducting a needs assessments, implementation, business models, and quality assurance.

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The era of virtual care: Perspectives of youth on virtual appointments in COVID-19 and beyond

Paediatrics & Child Health ◽

10.1093/pch/pxaa138 ◽

2021 ◽

Author(s):

Sarah E Fletcher ◽

Vivian W L Tsang

Keyword(s):

Health Care ◽

Physical Examination ◽

Health Care Providers ◽

Continuity Of Care ◽

Health Care Access ◽

Care Providers ◽

Care Access ◽

Virtual Care ◽

Time Savings ◽

Ease Of Access

Abstract In response to COVID-19, paediatric providers have shifted to providing outpatient health care appointments through telehealth. Youth perspectives on changes to health care access during the pandemic are important to consider when optimizing care for paediatric patients. Youth who contributed to this commentary reported that major benefits of virtual care included time savings, ease of access, continuity of care, and ability to participate in health appointments from the comfort of one’s own home without a risk of COVID-19 exposure. These youth also recognized limitations to virtual care, including the inability to complete laboratory or imaging tests, and the lack of physical examination capabilities. Additionally, they stressed the importance of visual components of virtual appointments and health care providers needing to consider privacy restrictions youth may have. Overall, our cohort of youth feel positive about virtual care and hope care providers can work with youth individually to determine the best solution for them.

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Sexual Orientation Differences in Adolescent Health Care Access and Health-Promoting Physician Advice

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2017.05.032 ◽

2017 ◽

Vol 61 (5) ◽

pp. 555-561 ◽

Cited By ~ 15

Author(s):

Jeremy W. Luk ◽

Stephen E. Gilman ◽

Denise L. Haynie ◽

Bruce G. Simons-Morton

Keyword(s):

Health Care ◽

Sexual Orientation ◽

Adolescent Health ◽

Health Care Access ◽

Physician Advice ◽

Care Access ◽

Health Promoting

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Health-Related Quality of Life among Members using an On-Demand Behavioral Health Platform: A Pilot Observational Study (Preprint)

10.2196/preprints.35352 ◽

2021 ◽

Author(s):

Emily Shih ◽

Brandon S. Aylward ◽

Sarah Kunkle ◽

Grant Graziani

Keyword(s):

Mental Health ◽

Behavioral Health ◽

Well Being ◽

Health Related Quality ◽

On Demand ◽

Virtual Care ◽

Related Quality ◽

Health Related

BACKGROUND Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire (PHQ-9) and/or General Anxiety Disorder (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, the current study utilized the health-related quality of life (HRQoL) tool from the Center for Disease Control and Prevention (CDC) “Healthy Days” measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical individuals and individuals with symptoms not meeting clinical thresholds. OBJECTIVE The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL. METHODS Two hundred and eighty-eight members completed the 4-item HRQoL measure at baseline and one-month following use of the Ginger on-demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively. RESULTS Members completed on average 1.92 coaching sessions (SD = 2.16) and 0.91 clinical sessions (SD = 1.37) during the assessment month. Paired samples t-tests revealed significant reductions in the average number of unhealthy mental health days between baseline (M = 16.0 days) and one month later (M = 13.2 days), and in the average number of days adversely impacted (M = 10.9, M = 8.19 at baseline and follow-up, respectively). Both subclinical members and members with clinically anxious and/or depressive symptoms demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days. Finally, member-engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days. CONCLUSIONS To our knowledge, this study is one of the first to utilize the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.

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