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Van Enst WA, Weng YC, Wanten SAC, Seyger MMB, Baerveldt EM, Arents BWM, De Jong EMGJ, Van den Reek JMPA. Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review. Acta Derm Venereol 2024; 104:adv23901. [PMID: 38751176 PMCID: PMC11110807 DOI: 10.2340/actadv.v104.23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/14/2024] [Indexed: 05/24/2024] Open
Abstract
Telemedicine, the provision of remote healthcare, has gained prominence, accelerated by the COVID-19 pandemic. It has the potential to replace routine in-person follow-up visits for patients with chronic inflammatory skin conditions. However, it remains unclear whether telemedicine can effectively substitute in-person consultations for this patient group. This systematic review assessed the effectiveness and safety of telemedicine compared with traditional in-person care for chronic inflammatory skin diseases. A comprehensive search in various databases identified 11 articles, including 5 randomized controlled trials (RCTs) and 1 clinical controlled trial (CCT). These studies evaluated telemedicine's impact on patients with psoriasis and atopic dermatitis, with varying methods like video consultations and digital platforms. The findings tentatively suggest that telemedicine does not seem to be inferior compared with in-person care, particularly in terms of condition severity and quality of life for patients with chronic inflammatory skin diseases. However, these results should be interpreted with caution due to the inherent uncertainties in the evidence. There are indications that telemedicine can offer benefits such as cost-effectiveness, time savings, and reduced travel distances, but it is important to recognize these findings as preliminary, necessitating further validation through more extensive research.
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Affiliation(s)
| | - Ying Chao Weng
- Dutch Society for Dermatology and Venereology, Utrecht, The Netherlands
| | - Sophie A C Wanten
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, The Netherlands
| | - Elke M G J De Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
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Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
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Zhang XJ, Lin J, Feng L, Ou M, Gong FQ. Non-pharmacological interventions for patients with psoriasis: a scoping review. BMJ Open 2023; 13:e074752. [PMID: 38000814 PMCID: PMC10679995 DOI: 10.1136/bmjopen-2023-074752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES Healthcare ultimately aims to eradicate diseases and restore normality to people's lives. However, until this is achieved for every person, there is a need to support and assist patients with psoriasis using non-pharmacological interventions. These 'adjuvant' approaches have received little attention, whereas dermatologists and researchers strive for better pharmacological therapy. Here, we aimed to perform a scoping review to identify and catalogue non-pharmacological interventions for patients with psoriasis. DESIGN A scoping review. SETTING All healthcare settings. SEARCH STRATEGY EMBASE, PubMed, CINAHL, PsycINFO and Scopus databases were searched from their inception to June 2022. Irrespective of the study type, the studies included non-pharmacological interventions for patients with psoriasis. This theme was extracted from the included articles. Two reviewers independently screened and analysed the data. RESULTS From 1322 initial records, 71 studies were identified and analysed. Non-pharmacological interventions for patients with psoriasis include two levels: organisational and individual. The organisational non-pharmacological interventions included the nationwide healthcare model (PsPSP, ProvenCare, German PsoHealth and Psoriasis Network, IMPROVE model and PsoWell clinic), innovative teledermatology models (mHealth app, electronic Targeted Intervention for Psoriasis study and therapist-guided internet-based cognitive and behavioural treatments) and multidisciplinary interventions. The individual non-pharmacological interventions included educational interventions (therapeutic patient education, psychoeducational intervention and self-management education), psychosocial interventions (cognitive and behavioural treatments, self-help and peer-to-peer support programmes) and others (happify and motivational interviewing-based training). CONCLUSIONS Based on previous literature, a nationwide healthcare model protocol was constructed for patients with psoriasis. This provided the direction for developing a new psoriasis healthcare model and a basis for summarising the non-pharmacological interventions for patients with psoriasis, which helps them adjust to changes in the skin disease.
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Affiliation(s)
- Xiu-Jie Zhang
- School of Public Health, China Medical University, Shenyang, Liaoning, China
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, Dalian, China
| | - Jingrong Lin
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, Dalian, China
| | - Li Feng
- Department of Dermatology, Dalian Dermatology Hospital, Dalian, China
| | - Minxing Ou
- Department of Dermatology, First Affiliated Hospital of Dalian Medical University, Dalian, Dalian, China
| | - Fu-Qing Gong
- School of Public Health, China Medical University, Shenyang, Liaoning, China
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Lopez-Liria R, Lopez-Villegas A, Valverde-Martinez MA, Perez-Heredia M, Vega-Ramirez FA, Peiro S, Leal-Costa C. Comparative Analysis of Quality of Life of Patients with Dermatological Problems: Teledermatology Versus Face-to-Face Dermatology. Healthcare (Basel) 2022; 10:2172. [PMID: 36360514 PMCID: PMC9691076 DOI: 10.3390/healthcare10112172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 04/20/2024] Open
Abstract
The health-related quality of life (HRQoL) of the patients cared for with teledermatology (TD) services was analyzed as compared with face-to-face dermatology (F-F/D) at the hospital. This study was a controlled, non-blinded, intra-level, and multicenter randomized clinical trial, with a 6-month follow-up. A total of 450 patients were randomly assigned to two different groups. The Spanish version of the generic EuroQol-5-dimensions-5-Levels (EQ-5D-5L) questionnaire and the specific Skindex-29 questionnaire were used at 0 and 6 months. The number of primary care visits (2.24 TD; 1.68 F-F/D) and number of hospital visits (0.01 TD; 1.48 F-F/D) were statistically significant. It was observed that from month 0 onwards, the users included in the F-F/D group self-perceived a lower HRQoL than the users included in the TD group (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). At the end of the study, the patients included in the F-F/D group still obtained lower scores in their perception of HRQoL, as compared to those included in the other type of follow-up (Skindex-29 total: p ≤ 0.00; EQ-5D-5L VAS = p ≤ 0.00; EQ-5D-5L utilities = p ≤ 0.00). TD was an effective diagnosis and follow-up tool. At the end of the study period, the HRQoL of the patients in both groups was significantly higher as compared to their baseline levels. Additionally, both the general and specific HRQoL perceived by the TD patients was higher than the F-F/D group from the start of the study.
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Affiliation(s)
- Remedios Lopez-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almeria, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain
| | | | - Maria Angeles Valverde-Martinez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almeria, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain
| | - Mercedes Perez-Heredia
- Research Management Department, Primary Care District Poniente of Almería, El Ejido, 04700 Almeria, Spain
| | | | - Salvador Peiro
- Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain
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Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient Teledermatology: a Review. CURRENT DERMATOLOGY REPORTS 2022; 11:52-59. [PMID: 35402084 PMCID: PMC8976271 DOI: 10.1007/s13671-022-00360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
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López-Liria R, Valverde-Martínez MÁ, López-Villegas A, Bautista-Mesa RJ, Vega-Ramírez FA, Peiró S, Leal-Costa C. Teledermatology versus Face-to-Face Dermatology: An Analysis of Cost-Effectiveness from Eight Studies from Europe and the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2534. [PMID: 35270227 PMCID: PMC8909884 DOI: 10.3390/ijerph19052534] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 02/04/2023]
Abstract
(1) Background: The aim of this systematic review was to compare the cost-effectiveness of two follow-up methods (face-to-face and telemedicine) used in dermatology in the last ten years. (2) Methods: A search for articles that included economic analyses was conducted in August 2021 in the databases PubMed, Medline, Scielo and Scopus using the following keywords: "Cost-Benefit Analysis", "Dermatology", "Telemedicine", "Primary Health Care", as well as other search terms and following the PICOS eligibility criteria. (3) Results: Three clinical trials and five observational studies were analyzed, providing information for approximately 16,539 patients (including four cost-minimization or saving analyses, three cost-effectiveness analyses, and one cost-utility analysis) in Europe and the United States. They describe the follow-up procedures in each of the cases and measure and analyze the direct and indirect costs and effectiveness. All the articles indicate that teledermatology lowers costs and proves satisfactory to both patients and professionals. (4) Conclusions: Although it has been found that follow-up via teledermatology can be more efficient than traditional hospital follow-up, more work is needed to establish evaluation protocols and procedures that measure key variables more equally and demonstrate the quality of the evidence of said studies.
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Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - María Ángeles Valverde-Martínez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almeria, Spain; (R.L.-L.); (M.Á.V.-M.)
| | - Antonio López-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido, Spain
| | | | | | - Salvador Peiró
- Health Services Research Unit, FISABIO-Public Health, 46020 Valencia, Spain;
| | - Cesar Leal-Costa
- Nursing Department, University of Murcia, 30120 El Palmar, Spain;
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Augustin M, Djamei V, Elsner P, Gass S, Hofmann-Wellenhof R, Kaminski K, Kirsten N, Nast A, Navarini-Meury A, Otten M, Salzer B, von Kiedrowski R, Zink A, Strömer K. S2k-Guideline for Teledermatology. J Dtsch Dermatol Ges 2021. [PMID: 34932269 DOI: 10.1111/ddg.14615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Steffen Gass
- Dermatological Practice Günzburg, Günzburg, Germany
| | | | | | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Navarini-Meury
- Department of Dermatology, Center for Skin Tumours, University Hospital Basel, Basel, Switzerland
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bernd Salzer
- Skin and Laser Center Heilbronn, Heilbronn, Germany
| | | | - Alexander Zink
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
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Skinner R, Breck A, Esposito D. An economic evaluation of teledermatology care delivery for chronic skin diseases. J Comp Eff Res 2021; 11:67-77. [PMID: 34747638 DOI: 10.2217/cer-2021-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Analyze the impact of nationwide implementation of teledermatological care for psoriasis. Methods: Develop a Markov model that estimates the impact of telehealth technology for treatment of moderate-to-severe psoriasis on health and healthcare expenditures compared with in-person clinical care. Results: Lower medical costs by US$1.5 billion and total social costs of US$4.3 billion over 5 years. Patients save more than 67 million hours in work absenteeism and travel time, valued at US$598 million. Employers save US$1.2 billion over 5 years due to decreased employee absenteeism. Conclusion: National implementation of telehealth for psoriasis care has the potential to substantially reduce both formal healthcare costs and informal costs for families and patients, while maintaining equivalent clinical outcomes as traditional in-person care.
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Affiliation(s)
| | - Andrew Breck
- Insight Policy Research, Inc., Arlington, VA 22209, USA
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Domogalla L, Beck A, Schulze-Hagen T, Herr R, Benecke J, Schmieder A. Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study. JMIR Mhealth Uhealth 2021; 9:e28149. [PMID: 34431478 PMCID: PMC8576562 DOI: 10.2196/28149] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Psoriasis has a negative impact on patients’ physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk
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Affiliation(s)
- Lena Domogalla
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Alena Beck
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Theresa Schulze-Hagen
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Benecke
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.,Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
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Lopez-Lopez L, Valenza MC, Rodriguez-Torres J, Torres-Sanchez I, Granados-Santiago M, Valenza-Demet G. Results on health-related quality of life and functionality of a patient-centered self-management program in hospitalized COPD: a randomized control trial. Disabil Rehabil 2019; 42:3687-3695. [DOI: 10.1080/09638288.2019.1609099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Snoswell CL, Whitty JA, Caffery LJ, Loescher LJ, Gillespie N, Janda M. Direct-to-consumer mobile teledermoscopy for skin cancer screening: Preliminary results demonstrating willingness-to-pay in Australia. J Telemed Telecare 2018; 24:683-689. [DOI: 10.1177/1357633x18799582] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Internationally, teledermoscopy has been found to have clinical and economic efficacy. This study aims to identify the attributes of a mobile teledermoscopy service that consumers prefer. This preliminary study was set within a broader randomised control trial (RCT) investigating the effectiveness of direct to consumer mobile teledermoscopy. Methods We undertook a discrete choice experiment (DCE). The DCE comprised 24 choice sets, divided into in two blocks of 12. For each choice set, respondents were asked to make discrete choices between two opt-out choices and two skin cancer screening service options described by seven attributes. A mixed logit model was used to estimate preferences for skin cancer screening services. Consumer preferences weights were used to calculate marginal willingness-to-pay (WTP) for skin cancer screening services. Results The DCE was completed by 113 consumer respondents. Consumers’ preference for dermatologist involvement in their diagnosis, increased accuracy, and reduced excisions were all statistically significant in driving choice between service models. Consumers preferred having a professional involved in their skin cancer screening, rather than performing a self-examination. Consumers were only WTP $1.18 to change from a GP visit to mobile teledermoscopy (diagnosis using a phone camera). However, they were WTP $43 to have their results reviewed by a dermatologist rather than a GP, and $117 to increase the chance of detecting a melanoma if it was present from 65-75% to 95%. Conclusion Skin cancer screening services which are delivered by health professionals, rather than skin self-examination, are preferred by consumers. Consumers were willing to pay for their preferred skin cancer screening method, especially if a dermatologist was involved.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | | | - Nicole Gillespie
- UQ School of Business, The University of Queensland, Queensland, Australia
| | - Monika Janda
- Queensland University of Technology, Institute for Health and Biomedical Innovation, Queensland, Australia
- The University of Queensland, Centre for Health Services Research, Brisbane, Australia
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12
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Torrent-Sellens J, Díaz-Chao Á, Soler-Ramos I, Saigí-Rubió F. Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners. J Med Internet Res 2018; 20:e279. [PMID: 30348628 PMCID: PMC6231736 DOI: 10.2196/jmir.9253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/04/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Abstract
Background The literature has noted the need to use more advanced methods and models to evaluate physicians’ outcomes in the shared health care model that electronic health (eHealth) proposes. Objective The goal of our study was to design and evaluate a predictive multidimensional model of the outcomes of eHealth usage by European physicians. Methods We used 2012-2013 survey data from a sample of 9196 European physicians (general practitioners). We proposed and tested two composite indicators of eHealth usage outcomes (internal practices and practices with patients) through 2-stage structural equation modeling. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage outcomes indicators were also calculated. Results European general practitioners who were female (internal practices OR 1.15, 95% CI 1.10-1.20; practices with patients OR 1.19, 95% CI 1.14-1.24) and younger—aged <35 years (internal practices OR 1.14, 95% CI 1.02-1.26; practices with patients OR 1.32, 95% CI 1.13-1.54) and aged 36-45 years (internal practices OR 1.16, 95% CI 1.06-1.28; practices with patients OR 1.21, 95% CI 1.10-1.33)—had a greater propensity toward favorable eHealth usage outcomes in internal practices and practices with patients. European general practitioners who positively valued information and communication technology (ICT) impact on their personal working processes (internal practices OR 5.30, 95% CI 4.73-5.93; practices with patients OR 4.83, 95% CI 4.32-5.40), teamwork processes (internal practices OR 4.19, 95% CI 3.78-4.65; practices with patients OR 3.38, 95% CI 3.05-3.74), and the doctor-patient relationship (internal practices OR 3.97, 95% CI 3.60-4.37; practices with patients OR 6.02, 95% CI 5.43-6.67) had a high propensity toward favorable effects of eHealth usage on internal practices and practices with patients. More favorable eHealth outcomes were also observed for self-employed European general practitioners (internal practices OR 1.33, 95% CI 1.22-1.45; practices with patients OR 1.10, 95% CI 1.03-1.28). Finally, general practitioners who reported that the number of patients treated in the last 2 years had remained constant (internal practices OR 1.08, 95% CI 1.01-1.17) or increased (practices with patients OR 1.12, 95% CI 1.03-1.22) had a higher propensity toward favorable eHealth usage outcomes. Conclusions We provide new evidence of predictors (sociodemographic issues, attitudes toward ICT impacts, and working conditions) that explain favorable eHealth usage outcomes. The results highlight the need to develop more specific policies for eHealth usage to address different realities.
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Affiliation(s)
- Joan Torrent-Sellens
- Faculty of Economics and Business, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Ángel Díaz-Chao
- Applied Economics Department, King Juan Carlos University, Madrid, Spain
| | - Ivan Soler-Ramos
- Faculty of Economics and Business, Universitat Oberta de Catalunya, Barcelona, Spain
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Augustin M, Wimmer J, Biedermann T, Blaga R, Dierks C, Djamei V, Elmer A, Elsner P, Enk A, Gass S, Henningsen M, Hofman-Wellenhof R, von Kiedrowski R, Kunz HD, Liebram C, Navarini A, Otten M, Reusch M, Schüller C, Zink A, Strömer K. Praxis der Teledermatologie. J Dtsch Dermatol Ges 2018; 16 Suppl 5:6-57. [DOI: 10.1111/ddg.13512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Johannes Wimmer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Hautklinik Campus Biederstein; Technische Universität München, München
| | - Rolf Blaga
- Psoriasis Selbsthilfe Arbeitsgemeinschaft e. V.; Berlin
| | | | | | - Arno Elmer
- Hochschule für Ökonomie und Management Berlin, Berlin
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena, Jena
| | - Alexander Enk
- Hautklinik; Universitätsklinikum Heidelberg, Heidelberg
| | | | - Maike Henningsen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | | | | | | | - Marina Otten
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | - Alexander Zink
- Dermatologischen Universitätsklinik; Technischen Universität München, München
| | - Klaus Strömer
- Gemeinschaftspraxis für Dermatologie und Allergologie; Mönchengladbach
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Abstract
Telemedicine is slowly transforming the way in which healthcare is delivered and has the potential to improve access to subspecialty expertise, reduce healthcare costs, and improve the overall quality of care. While many subspecialty fields within medicine today have either experimented with or begun to implement telemedicine platforms to enable remote consultation and care, dermatology is particularly suited for this care system as skin disorders are uniquely visible to the human eye. Through teledermatology, diagnostic images of skin disorders with accompanying clinical histories can be remotely reviewed by teledermatologists by any number of modalities, such as photographic clinical images or live video teleconferencing. Diagnoses and treatment recommendations can then be rendered and implemented remotely. The evidence to date supports both its diagnostic and treatment accuracy and its cost effectiveness. Administrative, regulatory, privacy, and reimbursement policies surrounding this dynamic field continue to evolve. In this review, we examine the history, evidence, and administrative landscape surrounding teledermatology and discuss current practice guidelines and ongoing controversies.
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Affiliation(s)
- Jonathan J Lee
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
- Teledermatology, UPMC North Hills Dermatology, 9000 Brooktree Rd Suite 200, Wexford, PA, 15044, USA.
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Trettel A, Eissing L, Augustin M. Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review. J Eur Acad Dermatol Venereol 2017; 32:215-224. [PMID: 28516492 DOI: 10.1111/jdv.14341] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/29/2017] [Indexed: 01/28/2023]
Abstract
Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.
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Affiliation(s)
- A Trettel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Kornmehl H, Singh S, Johnson MA, Armstrong AW. Direct-Access Online Care for the Management of Atopic Dermatitis: A Randomized Clinical Trial Examining Patient Quality of Life. Telemed J E Health 2017; 23:726-732. [PMID: 28570163 DOI: 10.1089/tmj.2016.0249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic disease requiring regular follow-up. To increase access to dermatological care, online management of AD is being studied. However, a critical knowledge gap exists in determining AD patients' quality of life in direct-to-patient online models. In this study, we examined quality of life in AD patients managed through a direct-access online model. MATERIALS AND METHODS We randomized 156 patients to receiving care through a direct-access online platform or in person. Patients were seen for six visits over 12 months. At each visit, the patients completed Dermatology Life Quality Index/Children's Dermatology Life Quality Index (DLQI/CDLQI), and Short Form (SF-12). RESULTS Between baseline and 12 months, the mean (standard deviation, SD) within-group difference in DLQI score in the online group was 4.1 (±2.3); for the in-person group, the within-group difference was 4.8 (±2.7). The mean (SD) within-group difference in CDLQI score in the online group was 4.7 (±2.8); for the in-person group, the within-group difference was 4.9 (±3.1). The mean (SD) within-group difference in physical component score (PCS) and mental component score (MCS) SF-12 scores in the online group was 6.5 (±3.8) and 8.6 (±4.3); for the in-person group, it was 6.8 (±3.2) and 9.1(±3.8), respectively. The difference in the change in DLQI, CDLQI, SF-12 PCS, and SF-12 MCS scores between the two groups was 0.72 (95% confidence interval [90% CI], -0.97 to 2.41), 0.23 (90% CI, -2.21 to 2.67), 0.34 (90% CI, -1.16 to 1.84), and 0.51 (90% CI, -1.11 to 2.13), respectively. All differences were contained within their equivalence margins. CONCLUSION Adult and pediatric AD patients receiving direct-access online care had equivalent quality of life outcomes as those see in person. The direct-access online model has the potential to increase access to care for patients with chronic skin diseases.
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Affiliation(s)
- Heather Kornmehl
- 1 Drexel University College of Medicine , Philadelphia, Pennsylvania
| | - Sanminder Singh
- 2 University of California , Davis School of Medicine, Sacramento, California
| | - Mary Ann Johnson
- 3 Department of Dermatology, Mercy Medical Group , Eldorado Hills, California
| | - April W Armstrong
- 4 Southern California Clinical and Translational Science Institute (CTSI) , Los Angeles, California
- 5 Department of Dermatology, Keck School of Medicine, University of Southern California , Los Angeles, California
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Pirhonen L, Olofsson EH, Fors A, Ekman I, Bolin K. Effects of person-centred care on health outcomes-A randomized controlled trial in patients with acute coronary syndrome. Health Policy 2016; 121:169-179. [PMID: 28062091 DOI: 10.1016/j.healthpol.2016.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/28/2016] [Accepted: 12/06/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To study the effects of person-centred care provided to patients with acute coronary syndrome, using four different health-related outcome measures. Also, to examine the performance of these outcomes when measuring person-centred care. DATA AND METHOD The data used in this study consists of primary data from a multicentre randomized parallel group, controlled intervention study for patients with acute coronary syndrome at Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention and control group consisted of 94 and 105 patients, respectively. The effect of the intervention on health-related outcomes was estimated, controlling for socio-economic and disease-related variables. RESULTS Patients in the intervention group reported significantly higher general self-efficacy than those in the control group six months after intervention start-up. Moreover, the intervention group returned to work in a greater extent than controls; their physical activity level had increased more and they had a higher EQ-5D score, meaning higher health-related quality of life. These latter effects are not significant but are all pointing towards the beneficial effects of person-centred care. All the effects were estimated while controlling for important socio-economic and disease-related variables. CONCLUSION The effectiveness of person-centred care varies between different outcomes considered. A statistically significant beneficial effect was found for one of the four outcome measures (self-efficacy). The other measures all captured beneficial, but not significant, effects.
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Affiliation(s)
- Laura Pirhonen
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Centre for Health Economics (CHEGU), Department of Economics, University of Gothenburg, Sweden.
| | - Elisabeth Hansson Olofsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30 Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden
| | - Kristian Bolin
- Centre for Health Economics (CHEGU), Department of Economics, University of Gothenburg, Sweden
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Pickett K, Loveman E, Kalita N, Frampton GK, Jones J. Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness. Health Technol Assess 2016; 19:1-176, v-vi. [PMID: 26502807 DOI: 10.3310/hta19860] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases. DATA SOURCES Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted. REVIEW METHODS Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses. RESULTS Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area. LIMITATIONS The application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported. CONCLUSIONS There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective. STUDY REGISTRATION This study is registered as PROSPERO CRD42014007426. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Emma Loveman
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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20
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Armstrong KA, Coyte PC, Bhatia RS, Semple JL. The effect of mobile app home monitoring on number of in-person visits following ambulatory surgery: protocol for a randomized controlled trial. JMIR Res Protoc 2015; 4:e65. [PMID: 26040252 PMCID: PMC4526905 DOI: 10.2196/resprot.4352] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/08/2015] [Indexed: 12/23/2022] Open
Abstract
Background Women’s College Hospital, Toronto, Canada, offers specialized ambulatory surgical procedures. Patients often travel great distances to undergo surgery. Most patients receiving ambulatory surgery have a low rate of postoperative events necessitating clinic visits. However, regular follow-up is still considered important in the early postoperative phase. Increasingly, telemedicine is used to overcome the distance patients must travel to receive specialized care. Telemedicine data suggest that mobile monitoring and follow-up care is valued by patients and can reduce costs to society. Women’s College Hospital has used a mobile app (QoC Health Inc) to complement in-person postoperative follow-up care for breast reconstruction patients. Preliminary studies suggest that mobile app follow-up care is feasible, can avert in-person follow-up care, and is cost-effective from a societal and health care system perspective. Objective We hope to expand the use of mobile app follow-up care through its formal assessment in a randomized controlled trial. In postoperative ambulatory surgery patients at Women’s College Hospital (WCH), can we avert in-person follow-up care through the use of mobile app follow-up care compared to conventional, in-person follow-up care in the first 30 days after surgery. Methods This will be a pragmatic, single-center, open, controlled, 2-arm parallel-group superiority randomized trial comparing mobile app and in-person follow-up care over the first month following surgery. The patient population will comprise all postoperative ambulatory surgery patients at WCH undergoing breast reconstruction. The intervention consists of a postoperative mobile app follow-up care using the quality of recovery-9 (QoR9) and a pain visual analog scale (VAS), surgery-specific questions, and surgical site photos submitted daily for the first 2 weeks and weekly for the following 2 weeks. The primary outcome is the total number of physician visits related to the surgery over the first 30-days postoperative. The secondary outcomes include (1) the total number of phone calls and emails to a health care professional related to surgery, (2) complication rate, (3) societal and health care system costs, and (4) patient satisfaction over the first 30 days postoperative. Permutated-block randomization will be conducted by blocks of 4-6 using the program ralloc in Stata. This is an open study due to the nature of the intervention. Results A sample of 72 (36 patients per group) will provide an E-test for count data with a power of 95% (P=.05) to detect a difference of 1 visit between groups, assuming a 10% drop out rate. Count variables will be analyzed using Poisson regression. Categorical variables will be tested using a chi-square test. Cost-effectiveness will be analyzed using net benefit regression. Outcomes will be assessed over the first 30 days following surgery. Conclusions We hope to show that the use of a mobile app in follow-up care minimizes the need for in-person visits for postoperative patients. Trial Registration Clinicaltrials.gov NCT02318953; https://clinicaltrials.gov/ct2/show/NCT02318953 (Archived by WebCite at http://www.webcitation.org/6Yifzdjph).
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Affiliation(s)
- Kathleen A Armstrong
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. J Am Acad Dermatol 2015; 72:563-74; quiz 575-6. [PMID: 25773407 DOI: 10.1016/j.jaad.2014.07.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/30/2022]
Abstract
Telemedicine is the use of telecommunications technology to support health care at a distance. Technological advances have progressively increased the ability of clinicians to care for diverse patient populations in need of skin expertise. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Moreover, there is a shortage of medical dermatologists in the United States, where skin disorders account for 1 in 8 primary care visits and specialists tend to congregate in urban areas. Even in regions where dermatologic expertise is readily accessible, teledermatology may serve as an alternative that streamlines health care delivery by triaging chief complaints and reducing unnecessary in-person visits. In addition, many patients in the developing world have no access to dermatologic expertise, rendering it possible for teledermatologists to make a significant contribution to patient health outcomes. Teledermatology also affords educational benefits to primary care providers and dermatologists, and enables patients to play a more active role in the health care process by promoting direct communication with dermatologists.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Joseph Kvedar
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard D Granstein
- Department of Dermatology, Weill Cornell Medical College, New York, New York.
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Byamba K, Syed-Abdul S, García-Romero M, Huang CW, Nergyi S, Nyamdorj A, Nguyen PA, Iqbal U, Paik K, Celi L, Nikore V, Somai M, Jian WS, Li YC. Mobile teledermatology for a prompter and more efficient dermatological care in rural Mongolia. Br J Dermatol 2015; 173:265-7. [PMID: 25494968 DOI: 10.1111/bjd.13607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- K Byamba
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - S Syed-Abdul
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | | | - C-W Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - S Nergyi
- Dermatology Center of Mongolia, Ulaanbaatar, Mongolia
| | - A Nyamdorj
- Allergymed Hospital, Ulaanbaatar, Mongolia
| | - P-A Nguyen
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - U Iqbal
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - K Paik
- Massachusetts Institute of Technology, Cambridge, MA, U.S.A
| | - L Celi
- Massachusetts Institute of Technology, Cambridge, MA, U.S.A
| | - V Nikore
- Massachusetts Institute of Technology, Cambridge, MA, U.S.A
| | - M Somai
- Department of Clinical Informatics, Harvard Medical School, Boston, MA, U.S.A
| | - W-S Jian
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Y-C Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
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Teledermatology: From historical perspective to emerging techniques of the modern era. J Am Acad Dermatol 2015; 72:577-86; quiz 587-8. [DOI: 10.1016/j.jaad.2014.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022]
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Hamilton M, Ntais D, Griffiths C, Davies L. Psoriasis treatment and management - a systematic review of full economic evaluations. Br J Dermatol 2015; 172:574-83. [DOI: 10.1111/bjd.13486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 01/11/2023]
Affiliation(s)
- M.P. Hamilton
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
| | - D. Ntais
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
| | - C.E.M. Griffiths
- Centre for Dermatology Research; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
- Salford Royal NHS Foundation Trust; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - L.M. Davies
- Centre for Health Economics; University of Manchester; Jean McFarlane Building Oxford Road Manchester M13 9PL U.K
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26
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Armstrong AW, Gelfand JM, Garg A. Outcomes Research in Psoriasis and Psoriatic Arthritis Using Large Databases and Research Networks: A Report from the GRAPPA 2013 Annual Meeting. J Rheumatol 2014; 41:1233-6. [DOI: 10.3899/jrheum.140178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Advances in healthcare informatics have increased the ability to address real-world, clinically relevant questions using large databases. When examining data sources, researchers and clinicians need to consider data validity, potential sources of misclassification, whether the source is sufficiently powered to detect clinically relevant differences, ability to obtain longitudinal data, containment of patients within a database, and ability to obtain structured point-of-care data. Population-based databases create opportunities for characterizing natural history of psoriatic diseases, conducting comparative effectiveness research, determining comorbidities, and providing epidemiology-based rational approaches to mechanistic investigations. Herein, we discuss the major data sources for clinical research in psoriasis, including electronic medical records, research networks, disease registries, and others.
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Abstract
OBJECTIVE This research uses the quality-adjusted life expectancy (QALE) method to assess the QALE changes of rural residents before and after introducing telemedicine health services. MATERIALS AND METHODS Based on Taiwan's experiences of telemedicine provision over the period 1995-2004, this representative of a national sample is composed of 85 cases for people living in Penghu County, a remote area in Taiwan. Cases were evaluated using persons with life expectancy at birth from 85 to 0 years. RESULTS The provision of telemedicine health services increased rural population QALE by 2.91 quality-adjusted life years. Telemedicine provision does improve rural residents' health status. Relative to the index population living in Taipei, the capital of Taiwan, the survival ratios of the population of concern >65 years decreased faster and were less than those of the index population >65 years by at least 7% and 3%, respectively, before and after introducing telemedicine health services. CONCLUSIONS It appears that the needs for telemedicine health services increased along with the aging of our society in rural and underserved regions.
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Affiliation(s)
- Fuhmei Wang
- Department of Economics in College of Social Science and Department of Public Health in College of Medicine, National Cheng Kung University , Tainan, Taiwan
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28
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Baker CS, Foley PA, Braue A. Psoriasis uncovered--measuring burden of disease impact in a survey of Australians with psoriasis. Australas J Dermatol 2013; 54 Suppl 1:1-6. [PMID: 23379483 DOI: 10.1111/ajd.12010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Internationally, the understanding of psoriasis has advanced in recent years to the point now where it is no longer considered a benign or cosmetic skin condition but a systemic, immune-mediated disease associated with significant comorbidities and considerable detriment to quality of life. The aim of this study was to gain a better understanding of the physical, psychosocial and medical burden of psoriasis on Australian adults and the impact on health status. METHODS Two large-scale multi-centre cross-sectional studies of Australian adults with psoriasis were conducted during 2010 and 2011, with the participation of a national patient representative group (Psoriasis Australia). The studies were based on detailed questionnaires that were self-completed by individuals with psoriasis. RESULTS A total of 362 and 330 completed surveys were received in 2010 and 2011, respectively. A significant physical, psychosocial and medical burden was reported by the respondents. It was noteworthy that patients reported actively concealing their disease from the general public (83%), work colleagues (65%), friends (58%), employers (49%), family (40%), close friends (39%) and spouse/partner (20%). The mean five-dimension European quality of life (EQ-5D) score for the 2011 cohort was 0.73, representing a significant impact on their HRQoL. The presence of comorbidities, found in three-quarters of the cohort, was associated with an even greater detriment to their HRQoL (mean score 0.64). CONCLUSIONS Psoriasis imposes a significant psychosocial burden on the lives of patients, including a profound impact upon their personal and professional relationships, social interactions and quality of life, to a degree comparable to other serious chronic conditions. This study highlights the importance of collaboration between primary and specialist health-care providers in developing patient management strategies that address the spectrum of physical and psychological manifestations associated with psoriasis.
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Affiliation(s)
- Chris S Baker
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia.
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Xie B, Wang M, Feldman R, Zhou L. Internet use frequency and patient-centered care: measuring patient preferences for participation using the health information wants questionnaire. J Med Internet Res 2013; 15:e132. [PMID: 23816979 PMCID: PMC3714005 DOI: 10.2196/jmir.2615] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/30/2013] [Accepted: 06/13/2013] [Indexed: 12/23/2022] Open
Abstract
Background The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions. Methods The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects. Results The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t436=17.42, P<.01). Internet use frequency was positively related to the overall preference rating (γ=.15, P<.05), suggesting that frequent Internet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57, P<.01); more information and more decision-making autonomy for laboratory test (γ=.15, P<.05), complementary and alternative medicine (γ=.32, P<.01), and self-care (γ=.15, P<.05); and less information but more decision-making autonomy for the psychosocial (γ=-.51, P<.01) and health care provider (γ=-.27, P<.05) aspects. No significant difference was found between frequent and infrequent Internet users in their preferences for treatment information and decision making. Conclusions Internet use frequency has a positive relationship with the overall preferences for obtaining health information and decision-making autonomy, but its relationship with different types of preferences varies. These findings have important implications for medical practice.
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Affiliation(s)
- Bo Xie
- School of Nursing & School of Information, University of Texas at Austin, Austin, TX, United States.
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Dancet EAF, Apers S, Kluivers KB, Kremer JAM, Sermeus W, Devriendt C, Nelen WLDM, D'Hooghe TM. The ENDOCARE questionnaire guides European endometriosis clinics to improve the patient-centeredness of their care. Hum Reprod 2012; 27:3168-78. [DOI: 10.1093/humrep/des299] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pereira F, Basra M, Finlay A, Salek M. The Role of the EQ-5D in the Economic Evaluation of Dermatological Conditions and Therapies. Dermatology 2012; 225:45-53. [DOI: 10.1159/000339865] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 11/19/2022] Open
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