A Comparative Study Of Direct-to-Consumer Telemedicine With Face-to-Face Outpatient Service For Postpartum Depression

Objective: To compare the quality of Direct-to-consumer telemedicine(DTCT)and face-to-face outpatient service(F2F)for postpartum depression,and to explore the possible factors influencing the difference in health care care service quality.Methods: This study used paired design and standardized patients(SP)with postpartum depression,who were used to evaluate the quality of health care services.Selected by a quota sampling,each psychiatrist was visited by trained and validated unannounced SPs(USPs)in DTCT and F2 F respectively,and USPs completed the forms of basic characteristics of visits and the health care quality checklists.Paired-sample hypothesis testing was used to analyze postpartum depression diagnosis(correct diagnosis rate),guideline adherence(consultation completion and disposition completion),time(waiting time and actual visit time),cost(consultation cost and total visit cost),and the quality of the delievery of "patient-centeredness"(average score of the PPPC-CN and average scores of its four dimensions)in both scenarios.Using the factors— whether the platform was a specialty platform,the city of the office visit,the level of the hospital,whether the hospital was a specialty hospital,the gender of the psychiatrist,and the title of the psychiatrist—as the independent variables,we conducted binary logistic regression and multiple linear regression model to explore the possible factors influencing the difference in the quality of DTCT and F2 F.Results: A total of 85 paired visits of DTCT and F2 F were completed in this study,and Mc Nemar’s testing showed that the diagnostic correctness of DTCT was lower than F2 F,P=0.006;the guideline adherence of DTCT was lower than F2 F,P<0.001;time spent in the care of DTCT was higher than offline,P<0.001;cost of consultations in DTCT was higher than F2 F,P<0.001,but the total cost of virtual visit was lower than office visit,P<0.001;the quality of the delievery of overall and all its four dimensions of "patient-centeredness" was lower in DTCT than F2 F,P<0.001.For the difference of diagnosis,compared to tertiary hospitals,when offline diagnosis was correct,paired visits in level II and below hospitals were more likely to have incorrect diagnosis online,with an OR of 5.607(95% CI: 1.082-29.044),P=0.040.For the consultation completion rate,larger differences of it were more likely to occur at paired visits in level III hospitals than in level II and below hospitals,with an OR of 17.222(95% CI: 2.022-146.718),P=0.009.For the disposition completion rate,compared to paried visits in the first provincial capital city cluster with "more" psychiatrists who served in DTCT,paired visits in the second provincial capital city cluster with "relative more" psychiatrists served in DTCT were more likely to have a larger difference in disposition completion rate,with OR of 9.004(95% CI: 1.324-61.243),P=0.025,and office visits in the psychiatric specialty hospitals had larger differences in disposition completion rates than their matched virtual visits,with an OR of 5.707(95% CI: 1.373-23.715),P=0.017.For the average score of PPPC-CN,the difference of it between office visits and their matched virtual visits was greater in the fourth provincial capital city cluster with "fewer" psychiatrists who served in DTCT compared to the first provincial capital city cluster,the value was 0.663(95% CI: 0.141-1.186),P=0.013.Conclusion: The quality of health care for postpartum depression in DTCT was lower than F2 F,mainly in terms of correct diagnosis,guideline adherence,time,cost of consultation,and "patient-centered" services.The city of the office visit,the level of the hospital,and whether office visits were in the specialty hospital or not,may be factors that influence the difference between the quality of health care in DTCT and F2 F.