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Study raises doubts about Dx and Tx being provided by a variety of DTC telemedicine websites and app

Patients must be cautious about the use of direct-to-consumer (DTC) teledermatology websites and smartphone apps, according to the results of a study published online by JAMA Dermatology (May 15, 2016).

During the study, Dr. Jack S. Resneck, Jr., professor and vice-chair of dermatology at the University of California, San Francisco, and coauthors used study personnel posing as patients to submit six dermatologic cases with photographs, including neoplastic, inflammatory and infectious conditions, to regional and national DTC telemedicine websites and smartphone apps offering services to California residents.

The photographs were mostly obtained from publicly available online image search engines. Study patients claimed to be uninsured and paid fees using Visa gift debit cards; no study personnel provided any false government-issued identification cards or numbers.

Responses were received from 16 DTC websites for 62 clinical encounters over about one month from Feb. to Mar. 2016.

Findings of the assessment suggested that incorrect diagnoses were made, treatment recommendations sometimes contradicted guidelines, and prescriptions frequently lacked disclosure about potential adverse effects and pregnancy risks.

A significant limitation to this study is that the authors were unable to assess whether clinicians seeing these patients in traditional in-person encounters would have performed any better.


The authors offer a series of recommended practices for DTC telemedicine websites, including obtaining proof of patient identity, collecting relevant medical history, seeking laboratory tests when an in-person physician would have relied on that information, having relationships with local physicians in all the areas where they treat patients, and creating quality assurance programs.

“Telemedicine has potential to expand access, and the medical literature is filled with examples of telehealth systems providing quality care. Our findings, however, raise doubts about the quality of skin disease diagnosis and treatment being provided by a variety of DTC telemedicine websites and apps . . . We believe that DTC telemedicine can be used effectively, but it is best performed by physicians and team members who are part of practices or regional systems in which patients already receive care,” the authors conclude.

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