Post-hurricane telemedicine use spiked, but largely provided routine care

By Dave Muoio
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An analysis of Doctor On Demand administrative data conducted by the RAND Corporation suggests that patients turning to direct-to-consumer telemedicine services in the days following natural disasters such as hurricanes are most often seeking routine care and guidance, as opposed to treatment for new issues prompted by the storms.

Still, the data suggest that the service (which Doctor On Demand, alongside others, offered for free during the disaster) saw a substantial influx of first-time and returning patients, with user counts reaching a peak between three and six days after hurricane landfall.

"Relying on direct-to-consumer telehealth services may help relieve the immediate burden on local health care system so that limited in-person care resources can be reserved for those patients with the greatest need,” Lori Uscher-Pines, senior policy researcher at RAND and the study’s lead author, said in a statement. "Our study illustrates the emerging role for direct-to-consumer telemedicine in disaster response.”

Uscher-Pines and colleagues (one of whom is a physician at Doctor On Demand) looked at a dataset that reached as far as 30 days after two hurricanes, Harvey and Irma, made their respective landfalls. Those using the service did so using Doctor On Demand’s mobile app or website, where they could receive an immediate physician consult that could lead to a diagnosis, prescription, or referral. These remote visits included those with out-of-state physicians who were allowed to provide care during the emergency while some of the state’s telemedicine regulations were temporarily lifted.

Of the 2,057 recorded visits through Doctor On Demand’s service, 63 percent were with first-time users. Nearly three-quarters of all patients were female, 14.4 percent were 17-years-old or younger, and 1.9 percent were 65-years-old or older.

Similar to national trends, calls for acute respiratory illnesses made up nearly a third of all telemedicine calls both in the first week after hurricanes and throughout the 30-day followup period. Skin problems were also frequent across all these groups.

Mental health calls, however, were substantially less frequent among those affected by the hurricanes, making up only 5.9 percent and 3.2 percent of calls during the 7-day and 30-day periods, respectively, as opposed to the 11.7 percent rate seen nationally. Calls concerning chronic conditions; advice, counseling, and refills; and back and joint concerns (including injuries) were more common one week after a hurricane compared to nationally.

“Interestingly, the most common conditions managed during these hurricanes were similar to what is addressed in non-disaster contexts,” the researchers wrote. “While there was higher demand for care for chronic illness, overall, our data suggest that [direct-to-consumer] telemedicine focuses on the routine needs of new telemedicine users and less on new issues precipitated by the disaster.”

The researchers also noted that the majority of calls (52.6 percent) were handled by physicians located out the state being affected by a hurricane, an aspect of the platform that the researchers highlighted as a “key advantage” during disaster responses.

"Our study suggests that direct-to-consumer telemedicine is a new way to deliver routine health care to people in the immediate aftermath of a natural disaster, although it does require that certain infrastructure like cellular service and Wi-Fi remain intact," Uscher-Pines said in a statement.

Infrastructure preparation has been a growing focus for telemedicine providers and health networks prior to an oncoming natural disaster, a number of sources told MobiHealthNews at the time of the hurricanes. Most recently, these preparation efforts have also included raising awareness of free services, partnering with local and national emergency care services, and recruiting more eligible providers to the platform.