by Dennis Thompson

Online-only health care services have become a trendy way for people to receive low-cost medical attention.

These websites don't require a referral or health insurance and offer a flat service fee. The online providers evaluate symptoms, make diagnoses, and even prescribe medicines.

But older Americans aren't having any of it, at least for now, a new survey shows.

Only 7.5% of people between the ages of 50 and 80 have used one of these direct-to-consumer health care services, according to findings from the University of Michigan's National Poll on Healthy Aging.

Middle-aged folks in the pre-Medicare years of 50 to 64 were more than twice as likely as adults over 65 to have used one of these online health services—10% versus 4%.

Nearly half (47%) of people older than 65 said they'd never heard of such companies.

Still, nearly a third of older adults said they'd be interested in using such services in the future. That number was even higher, more than 42%, among those ages 50 to 64.

Dr. Mark Fendrick, a primary care physician at the University of Michigan, expects that more seniors will become interested in using these online services over time.

"Patients will increasingly seek care online because of the convenience it can provide, especially for those willing to pay the cost out of pocket," said Fendrick, director of Michigan's Center for Value-Based Insurance Design.

"Its use will likely be boosted by the rapidly increasing number of online vendors and the national shortage of primary care clinicians," Fendrick added in a university news release. "The recent launch of a telemedicine platform offering home delivery for the new highly popular weight-loss drugs is a noteworthy example of this trend."

Online health care sites like Amazon Clinic, Sesame, Roman, BetterHelp, Rosy, Lemonaid and Hims & Hers have sprung up in recent years, offering convenient online access to providers.

It's the virtual equivalent of "doc-in-a-box" clinics operated by companies like ZoomCare, Zocdoc, Doctor On Demand and HealthTap.

Even membership-based organizations like Weight Watchers and Costco have started offering access to such direct services, researchers said in background notes.

These sites gained traction during the pandemic, as people turned to telehealth as part of social distancing.

In fact, the poll found that 58% of those who had used an online health service started doing so in 2020, 2021 or 2022.

Most older adults who had used one of these services said they were driven by convenience, the survey shows.

More than 60% received a prescription, mostly for a one-time treatment. However, only a third of told their regular doctor about the prescription.

What's more, one-third of those who used an online-only service said their doc wasn't aware they'd done so.

This has raised some concerns that patients will be prescribed medicines that could interact in harmful ways with other drugs they're already taking, Fendrick said.

The online providers don't have access to the patient's full health history or medical records, so they can't check for potentially dangerous drug interactions.

"These compelling findings have important implications for patient safety and continuity of care," Fendrick said. "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."

Nearly half of older Americans who used an online-only health service said it was for general health care, such as treatment of allergies, sinus infections, pink eye or acid reflux, poll results show.

Other types of care included sexual health issues (15%), mental health services (12%), skin care (9%), weight management (6%), hair loss (5%) and pain management (5%).

Convenience was the top reason older adults chose an online health provider, with 55% saying this drove their decision.

But around 20% cited other compelling reasons—a lack of access to their regular doctor, not having a regular health care provider or needing a service when their family clinic wasn't open or available.

Discomfort discussing a sensitive health topic with their doctor prompted 10% of respondents to turn to an online health service.

"For both patients and providers, these findings drive home the importance of open dialogue and transparency about the potential uses, benefits and risks of these services—and the importance of maintaining contact for ongoing primary care," said Dr. Jeffrey Kullgren, director of the poll and an associate professor at the University of Michigan Medical School.

More than 55% of those who'd used an online health service still felt they got overall better quality of care from their primary care provider, the poll found.

Doctors and patients need to establish a back-and-forth about the use of online health services, to keep primary care providers up to date, Fendrick said.

"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."

The poll was administered online and via phone in July and August 2023 among 2,657 adults 50 to 80. In all, 168 participants reported having used an online health care service.

More information: The U.S. Department of Health and Human Services has more about direct-to-consumer online health care.

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