Direct-to-Consumer Chat-Based Remote Care Before and During the COVID-19 Outbreak

  1. Dan Zeltzer
  2. Alina Vodonos
  3. Edo Paz
  4. Roy Malka

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Abstract

Objective

To compare the patient population, common complaints, and physician recommendations in direct-to-consumer chat-based consults, before and during the COVID-19 outbreak.

Data sources

Data on patient characteristics, patient complaints, and physician recommendations from 36,864 chat-based telemedicine consults with physicians in an online-clinic by patients from across the United States between April 2019 and April 2020.

Study Design

We perform a retrospective analysis comparing patient characteristics, visit characteristics, and physician recommendation before and after the COVID-19 outbreak. We examine patient age and gender, visit time, patient chief complains, and physician medical recommendation (including prescription drugs, reassurance, and referrals).

Principal Findings

Before March 2020, most patients were female (75 percent) and 18–44 years old (89 percent). Common complaints such as abdominal pain, dysuria, or sore throat suggested minor acute conditions. Most cases (67 percent) were resolved remotely, mainly via prescriptions; a minority were referred. Since March 2020, the COVID-19 emergency has led to a sharp (fourfold) increase in case volume, including more males (from 25 to 29 percent), patients aged 45 and older (from 11 to 17 percent), and more cases involving mental health complaints and complaints related to COVID-19. Across all symptoms, significantly more cases (78 percent) have been resolved remotely.

Conclusions

The COVID-19 outbreak in the United States has been associated with a sharp increase in the use of chat-based telemedicine services, including by new patient demographics, an increase in both COVID-19 and mental health complains, and an increase in remote case resolutions.

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  1. ScreenIT

    SciScore for 10.1101/2020.07.14.20153775: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    About SciScore

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  2. Version published to 10.1101/2020.07.14.20153775v1 on medRxiv