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Assessing quality of direct-to-consumer telemedicine in China: a cross-sectional study using unannounced standardised patients
  1. Zhen Zeng1,
  2. Dong (Roman) Xu2,
  3. Yiyuan Cai3,
  4. Wenjie Gong1,4,5
  1. 1HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
  2. 2SMU Institute for Global Health (SIGHT), School of Health Management and Dermatology Hospital, Southern Medical University (SMU), Guangzhou, China
  3. 3Department of Epidemiology and Health Statistics, School of Public Health, Guizhou Medical University, Guiyang, China
  4. 4Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
  5. 5Department of Psychiatry, University of Rochester, Rochester, New York, USA
  1. Correspondence to Professor Wenjie Gong, HER Team and Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, Hunan, 410078, China; gongwenjie{at}


Direct-to-onsumer telemedicine (DTCT) has become popular as an alternative to traditional care. However, uncertainties about the potential risks associated with the lack of comprehensive quality evaluation could influence its long-term development. This study aimed to assess the quality of care provided by DTCT platforms in China using unannounced standardised patients (USP) between July 2021 and January 2022. The study assessed consultation services on both hospital and enterprise-sponsored platforms using the Institute of Medicine quality framework. It employed 10 USP cases, covering conditions such as diabetes, asthma, common cold, gastritis, angina, low back pain, child diarrhoea, child dermatitis, stress urinary incontinence and postpartum depression. Descriptive and regression analyses were employed to examine platform characteristics and compare quality across platform types. The results showed that of 170 USP visits across 107 different telemedicine platforms, enterprise-sponsored platforms achieved a 100% success in access, while hospital-sponsored platforms had a success rate of only 47.5% (56/118). Analysis highlighted a low overall correct diagnosis rate of 45% and inadequate adherence to clinical guidelines across all platforms. Notably, enterprise-sponsored platforms outperformed in accessibility, response time and case management compared with hospital-sponsored platforms. This study highlights the suboptimal quality of DTCT platforms in China, particularly for hospital-sponsored platforms. To further enhance DTCT services, future studies should compare DTCT and in-person care, aiming to identify gaps and potential risks associated with using DTCT as alternatives or supplements to traditional care. The potential of future development in enhancing DTCT services may involve exploring the integration of hospital resources with the technology and market capabilities of enterprise-sponsored platforms.

  • Health services research
  • Quality measurement
  • Performance measures
  • Patient-centred care

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  • Contributors WG conceived the study. ZZ coordinated the daily implementation of this study under the supervision of DRX, YC and WG. ZZ carried out data analysis and composed the initial manuscript draft, receiving guidance from WG and DRX. All authors contributed to critical review of the manuscript and approved the final draft.

  • Funding This study was funded by China Medical Board (20-368), Swiss Agency for Development and Cooperation (81067392) and the National Natural Science Foundation of China (82273643).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.