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

ObjectiveTo compare the patient population, common complaints, and physician recommendations in direct-to-consumer chat-based consults, before and during the COVID-19 outbreak. Data sourcesData 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 DesignWe 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 FindingsBefore 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. ConclusionsThe 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.