A Third of Older Adults Using DTC mHealth Services Do Not Tell PCPs

Though a small proportion of older adults use direct-to-consumer (DTC) mHealth services, one-third do not share that information with their primary care physician (PCP), new survey results released by the University of Michigan’s Institute for Healthcare Policy and Innovation (IHPI) show.

Conducted by NORC at the University of Chicago for IHPI, the survey was administered online and via phone in July and August 2023. The survey polled 2,657 adults aged 50 to 80, of which 168 reported having used a DTC healthcare service. These services include DTC telehealth and e-prescription sites, subscription-based mHealth apps, and membership-based organizations and retailers, like Costco, that have launched DTC healthcare services.

The survey shows that 7.5 percent of people between 50 and 80 have used at least one DTC healthcare service from an online-only provider. People aged 50 to 64 were more than twice as likely as those over 65 to have used DTC healthcare services, with 10 percent of the former and 4 percent of the latter saying they have used these services. Nearly half (47 percent) of people over 65 said they had never heard of DTC companies.

Among those who used a DTC healthcare service, 62 percent used it to receive a prescription, 12 percent for mental health reasons, 15 percent for a sexual health issue, 9 percent for skin care, 6 percent for weight management, and nearly 5 percent for hair loss and pain management, respectively.

“With rapid growth in this sector of health care predicted for this year and beyond, all providers, insurers and regulators need to pay more attention to how patients are using these services and why, and the impact on care quality and safety,” said Mark Fendrick, MD, director of the University of Michigan’s Center for Value-Based Insurance Design, an IHPI member, and primary care physician at Michigan Medicine, in a press release.

About 55 percent of respondents cited convenience as the main reason for using a DTC healthcare service; however, 20 percent cited lack of access to their regular healthcare provider, another 20 percent cited not having a regular healthcare provider, and 20 percent cited needing a service when their healthcare provider was not open or available as the main reasons. Only 10 percent of respondents cited discomfort in discussing a sensitive health topic with their provider as driving their decision to seek a DTC service.

One-third of older adults who used DTC healthcare services did not tell their regular PCP, and one-third of those who used a DTC service to receive a prescription said their PCP was not made aware of the new medication prescribed. This could lead to care fragmentation and patient safety issues.

“Given a likely expansion of online care, it is critical that individuals inform their usual clinician and that we providers consistently ask our patients regarding their use,” Fendrick said. “Similar to my routinely asking patients about which supplements, vitamins and over-the-counter medications they’re taking, it should become standard practice for me to inquire about prescriptions or diagnoses they’ve received online, as it might influence their care.”

Though guardrails are needed to protect patients using DTC healthcare services, most older adults strongly prefer receiving care from their regular physicians. The survey showed that more than 55 percent of respondents said the overall quality of care they get from their PCP is better than that from a DTC provider.

This aligns with prior research, which showed that 72 percent of telehealth users reported accessing virtual appointments through their doctor or health insurance. In comparison, 17 percent said they used on-demand telehealth services. This survey, released in 2021, polled 2,200 individuals.