May 18, 2024

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Direct-to-consumer health services may pose risks for older adults

3 min read

Nearly a third of all adults ages 50 to 80, and more than 42% of those ages 50 to 64, said they’re interested in using direct-to-consumer services in the future, according to a poll released by the University of Michigan earlier this year. This trend is something journalists should follow closely because it could foreshadow some potentially dangerous interactions for older adults.

The rise of direct-to-consumer sites and subscription-based apps that promise convenient online access to providers who can evaluate symptoms, make diagnoses and prescribe medication sounds promising in an era of primary care physician shortages. However, these providers often don’t have a complete patient health history, and may not be fully aware of a patient’s other medications or conditions, leading to possible serious drug interactions, higher fall risk or other unforeseen consequences.

Why this matters

Almost all (90%) of older adults take at least one prescription drug, and 80% take two, according to a 2021 study. More than one-third (36%) take at least five different medications.

The poll revealed that people in their pre-Medicare years of ages 50 to 64 were more than twice as likely as adults over 65 to have used direct-to-consumer online health services (10% vs. 4%). Meanwhile, 47% of those over 65 said they had never heard of online-only health companies.

“These compelling findings have important implications for patient safety and continuity of care,” Mark Fendrick, M.D., a primary care physician, professor of internal medicine and director of the University of Michigan’s Center for Value-Based Insurance Design, said in a statement. “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.” 

It should become standard practice for all providers to inquire about prescriptions or diagnoses patients may have received online, as it might influence their care, according to Fendrick.

Amazon Clinic, Sesame, Roman, and BetterHelp are just some of the companies offering direct-to-consumer health services and products. They don’t require a referral or health insurance. Drug companies such as Eli Lilly and membership-based organizations like Weight Watchers and Costco have also started offering access to such direct services. 

Types of care received

Nearly half of people who had used a direct-to-consumer health service said it has been for general health care such as treatment of allergies, sinus infections, pink eye or acid reflux.

Here’s a breakdown of how people ages 50 to 80 use the services:

  • Mental health reasons: 12%.
    • This proportion was much higher (50%) among those who said they considered their mental health to be fair or poor and had used a direct-to-consumer service of any kind.
  • Sexual health issue: 15%.
  • Weight management: 9%.
  • Skin care: 9%.
  • Hair loss: Approximately 5%.
  • Pain management: Approximately 5%.

More than half (55%) said the convenience factor drove their decision. But one in five (20%) cited lack of access to their regular health care provider, not having a regular health care provider, or needing a service when their health provider was not open or available. Only 10% mentioned discomfort discussing a sensitive health topic with a provider. 

The poll was a nationally representative survey conducted by NORC at the University of Chicago for the University of Michigan Institute for Healthcare Policy and Innovation and administered online and via phone in July and August 2023 among 2,657 adults aged 50 to 80. In all,168 respondents reported having used a direct-to-consumer health care service. The sample was subsequently weighted to reflect the U.S. population. 

While this analysis included a relatively small group of patients, it’s a trend that providers who care for older adults, and journalists who report on the aging population,  should keep an eye on.   

Resources

  • Ethical issues in direct-to-consumer healthcare: A scoping review, PLOS Digital Health.
  • At-Home Consumer Tests Raise Ethical, Health, and Privacy Questions, University of Pennsylvania Leonard Davis Institute of Health Economics.
  • Artificial Intelligence, Data Privacy, and How to Keep Patients Safe Online, Institute for Healthcare Improvement.
  • Eli Lilly launches service to connect patients with telehealth care, deliver medications to their homes, CNN (January 2024).
  • Why it’s time for a digital, direct-to-consumer health care revolution, Ernst and Young.

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