The quality of direct-to-consumer telemedicine services for sexually transmitted infections in China: results from a standardized patient survey (Preprint)

BACKGROUND Background: The burden of sexually transmitted infections (STIs) continues to increase in developing countries like China, but the access to STI care is often limited. The emergence of direct-to-consumer (DTC) telemedicine offers unique opportunities for patients to directly access health services when needed; However, the quality of STI care provided by telemedicine platforms remains unknown. OBJECTIVE This study aims to evaluate the quality of STI care services provided on DTC telemedicine platforms in a national representative market in China and explore how the quality is associated with observable characteristics of platforms and providers. METHODS We performed a nationwide screening survey of DTC telemedicine platforms providing healthcare services in China. After that, we evaluated their quality using the method of unannounced standardized patients (SPs). SPs presented routine cases of syphilis and herpes. The quality of STI care services was assessed by adherence to a checklist of recommended questions and exams, adherence to an “essential” checklist, and the provision of correct diagnosis and management. Generalized linear models and probit regressions were constructed to examine the associated platform and provider characteristics. A decision tree method was used to understand the causes of undesired quality outcomes. RESULTS Of 110 SP visits conducted, physicians made a correct diagnosis in 44.5% (95% CI: 35.1% to 54.0%) of SP visits, and correctly managed 10.9% (95% CI: 5.0% to 16.8%). Low rates of correct management were primarily attributable to the failure of physicians to refer patients for STI testing. Controlling for other factors, videoconference (vs. SMS-based) consultation mode and the availability of public physician ratings were associated with higher-quality care. CONCLUSIONS Our findings suggest a need for further research on the causal determinants of care quality on DTC telemedicine platforms and effective policy approaches to promote their potential to expand access to STI care in developing countries while limiting potential unintended consequences for patients. CLINICALTRIAL Not needed