October 22, 2019

The doctor will text you now: Inside the rise of text message-based care

Daily Briefing

    Companies such as CirrusMD, 98point6, and K Health provide care to patients quickly via text message, but while these services are growing in popularity, some experts worry that the practice could lead to lower-quality care and overprescribing, Tom Murphy reports for the Associated Press.

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    Why text message-based care is becoming popular

    These text message-based health care companies provide treatment for injuries and minor illnesses that would otherwise be handled by a doctor's office or clinic, Murphy reports, and they're becoming more popular. For instance, 98point6, which uses a chatbot for diagnostics, launched in January 2018 with 600 customers and expects to have around one million signed up by the end of this year, Murphy reports.

    Customers of 98point6 describe their symptoms to a chatbot that uses an algorithm to determine what questions to ask, and that information is relayed to a doctor for their diagnosis and treatment recommendations, Murphy reports. According to 98point6 CEO Robbie Cape, "There are many, many cases where the physician does not have to ask a single additional question."

    A number of patients have access to these types of services through their insurance. For example, around three million people nationwide have access to CirrusMD through their insurance, Murphy reports.

    Blake McKinney, co-founder of CirrusMD, said he believes that text messaged-based health care appeals to generations of consumers who "are becoming accustomed to being able to access all types of service with their thumbs."

    Some experts express concerns

    But despite the apps' growing popularity among patients, some experts have expressed concerns about text message-based health care services, Murphy reports. For example, Thomas Bledsoe, a member of the American College of Physicians, said he worried the quality of care provided by physicians via text may not be as high as it would be if the patient was seen in person.

    He added, "If the business opportunity is huge, there's a risk that that caution is pushed aside."

    However, text message-based providers say they take steps to ensure the safety of their patients and recommend in-person doctor visits when needed. For example, Anna Nguyen, an emergency physician who works with CirrusMD, once told an 85-year-old patient who contacted CirrusMD about crushing chest pain to go to the ED.

    Even still, Bledsoe said he was concerned about the fact that text message-based care often involves a physician who doesn't know the patient or their medical history.

    "Sometimes what seems to be a limited problem to a patient is actually part of a bigger problem that requires some more evaluation and treatment," Bledsoe said. For example, a patient who wants a prescription for a bladder infection may actually need a cancer test, he noted.

    The companies, however, argue that a thorough medical history isn't necessary for every case. They estimated they can resolve over 80% of their cases exclusively through messaging, though patients have the option to chat via video or phone conversation if needed.

    Another critique of text message-based care is that it could also lead to overprescribing of antibiotics, according to Ateev Mehrota, a researcher with Harvard University. He added that it's likely easier for a doctor who knows a patient to explain to them in person why they don't need a medication than it would be for a stranger to say the same via text.

    CirrusMD and 98point6 both said they closely monitor their antibiotic prescription rates, and neither company prescribes highly addictive painkillers. In addition, 98point6 sends doctors through six months of training, Murphy reports. Instead of harming care, these message-based companies argue they are improving health care access, especially if someone's regular physician isn't available.

    According to Cape, "We're meant to fit into your life" (Murphy, Associated Press, 10/8).

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