Users' Perspectives of Direct-to-Consumer Telemedicine Services: Survey Study.

Background: Commercially run direct-to-consumer (DTC) telemedicine services are on the rise in countries such as Australia and the United States. These include DTC services that are web-based, largely asynchronous, and offer targeted treatment pathways for specific health issues (eg, weight loss or sexual function). It has been argued that DTC telemedicine improves access to health care and promotes patient empowerment. Despite research examining quality and safety issues, little is known about users' reasons for accessing DTC telemedicine services or their perceptions of them. Objective: In this study, we aimed to examine the perspectives of Australian users accessing DTC telemedicine services, including the reasons for use, perceived benefits, and concerns, in addition to their usage and interaction with traditional general practice services. Methods: A web-based cross-sectional survey including questions on demographics, published and validated scales, and author-developed closed- and open-response questions was administered via REDCap in 2023 to Australian adults accessing DTC telemedicine services. Results: Among the 151 respondents, most (136/151, 90.1%) had seen a general practitioner (GP) in the previous 12 months and were somewhat or very satisfied (118/136, 86.8%) with the care, just over half found it easy to get an appointment with their GP (76/151, 50.3%), and a quarter found it difficult (38/151, 25.2%). Among the 136 respondents who had seen a GP, more than half either "never" (55/136, 40.4%) or "rarely" (23/136, 16.9%) discussed the information and treatment received from DTC telemedicine service with their GP. The majority of respondents were using a DTC telemedicine service offering prescription skin care (92/151, 60.9%), had received treatment in the previous 6 months (123/151, 81.5%), and had self-initiated care (128/151, 84.8%). The most frequently cited reasons for using DTC telemedicine were related to convenience (97/121, 80.2%) and flexibility (71/121, 58.7%), while approximately a third of the sample selected that it was difficult to see traditional health care provider in their preferred time frame (44/121, 36.4%) and that the use of DTC telemedicine allowed them to gain access to services otherwise unavailable through traditional health care (39/121, 32.2%). Most participants felt "more in control" (106/128, 82.9%) and "in charge" of their health concern (102/130, 78.5%) when using DTC telemedicine services, in addition to having "more correct knowledge" (92/128, 71.9%) and "feeling better informed as a patient" (94/131, 71.8%). "Costs of services" (40/115, 34.8%) and "privacy" (31/115, 27%) were the most frequently reported concerns with using digital health care technologies such as DTC telemedicine. Conclusions: We report that most users perceive DTC telemedicine services as offering ease of access and convenience, and that their use contributes to a greater sense of empowerment over their health. Concerns were related to data privacy and the costs of utilizing the services. Responses suggest that DTC telemedicine may be tapping into a previously unmet need, rather than complementing traditional health care provided by a GP.