I recently raised the topic of specialized direct-access-testing (DAT) sites that offer STD tests (see: Direct Access Testing For STDs: How to Communicate with Young Adults). In the note, I glossed over the issue of whether such test orders are reviewed by physicians. Julie Springer, who works for STDtestExpress, responded with the following comment:
...[A]ctually STDtestExpress and YouNeverReallyKnow both involve physician-approved test orders facilitated through a third-party Tele-medicine partner. And, if a patient tests positive for an STD - a consultation with a licensed physician is included in the price! Thanks for blogging about us - we're pretty excited about what we're able to offer these patients.
The earliest DAT web sites tended to operate only in those states where such testing was permitted absent physician participation. Quest later launched a DAT service, which was not successful and was closed down rather quickly, called QuesTest (see: QuesTest Bails Out of the DAT Market). The company goal was to operate in most of the states in order to generate sufficient test volume so it contracted for the services of an on-line physician network to participate in all test orders. In essence, the customer requested lab tests via the site and the lab test orders were ordered by the physicians working for the network and who were duly licensed in the state of the customer. I would characterize this arrangement as a pro forma response to the state laws in the sense that the test ordering physicians had little if any direct contact with the customers and little knowledge of their medical histories.
As Julie emphasizes above, STD testing via a DAT business model is a different kettle of fish. The critical need for physician intervention occurs primarily when a patient tests positively for a test. As she also points out and in the case of the two STD sites mentioned, "a consultation with a licensed physician is included in the price." To restate the obvious, such a consultation is particularly important for a life-threatening infections such as AIDS but also certainly relevant for any STD. Ideally, such consultation is provided in a face-to-face setting but web-enabled testing and consultation is better than no testing at all.