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Nikolakis G, Vaiopoulos AG, Georgopoulos I, Papakonstantinou E, Gaitanis G, Zouboulis CC. Insights, Advantages, and Barriers of Teledermatology vs. Face-to-Face Dermatology for the Diagnosis and Follow-Up of Non-Melanoma Skin Cancer: A Systematic Review. Cancers (Basel) 2024; 16:578. [PMID: 38339329 PMCID: PMC10854718 DOI: 10.3390/cancers16030578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Teledermatology is employed in the diagnosis and follow-up of skin cancer and its use was intensified during and after the COVID-19 pandemic. At the same time, demographic changes result in an overall increase in non-melanoma skin cancer and skin precancerous lesions. The aim of this study was to elucidate the role of teledermatology in comparison to conventional face-to-face dermatology for such lesions and determine the advantages and limitations of this workflow for patients and physicians. METHODS Research was performed using relevant keywords in MEDLINE and CENTRAL. Relevant articles were chosen following a predetermined standardized extraction form. RESULTS Diagnostic accuracy and interrater/intrarater agreement can be considered comparable-although lower-than in-person consultation. Improvement of particular features such as image quality, medical history availability, and teledermoscopy can further increase accuracy. Further aspects of limitations and advantages (mean time-to-assessment, time-to-treatment, cost-effectiveness) are discussed. CONCLUSIONS Teledermatology has comparable diagnostic accuracy with face-to-face dermatology and can be utilized both for the effective triage of non-melanocytic epithelial tumors and precancerous lesions, as well as the follow-up. Easy access to dermatologic consultation with shorter mean times to diagnostic biopsy and/or treatment coupled with cost-effectiveness could compensate for the lower sensitivity of teledermatology and offer easier access to medical care to the affected populations.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
- Docandu Ltd., London Ν8 0ES, UK;
| | - Aristeidis G. Vaiopoulos
- Second Department of Dermatology and Venereology, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Ioannis Georgopoulos
- Docandu Ltd., London Ν8 0ES, UK;
- Surgical Department, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | | | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
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Kheterpal MK, Borre ED, Cheema U, Nicholas MW, Cooner EW, Phinney D, Gagnon K, Zullig LL, King HA, Malcolm EJ, Chen SC. Implementation evaluation of a teledermatology virtual clinic at an academic medical center. Implement Sci Commun 2023; 4:130. [PMID: 37891695 PMCID: PMC10612341 DOI: 10.1186/s43058-023-00508-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Teledermatology (TD) is an evidence-based practice that may increase access to dermatologic care. We sought to use the Exploration, Preparation, Implementation, and Sustainment (EPIS) and the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) frameworks to evaluate implementation of TD at Duke. METHODS The EPIS and RE-AIM frameworks were deployed to design and implement a TD program that leveraged the strengths of the Duke University Health System and addressed previously reported barriers to implementation of store-and-forward and synchronous TD models. In the resultant hybrid TD model, trained primary care providers (PCPs) sent e-comm referrals with clinical and dermatoscopic images to dermatology. These e-consults were reviewed asynchronously and patients were scheduled for a synchronous video visit with dermatology within days. Dermatologists managed the patient plan. This hybrid TD model was piloted at four primary care clinics. Pertinent outcomes from a TD-adapted RE-AIM framework were tracked using electronic health record data. Patient satisfaction was assessed using a post-video visit survey (n = 18). Implementation barriers and facilitators were also collected through provider surveys (n = 24 PCPs, n = 10 dermatologists, n = 10 dermatology residents). RESULTS At four PCP clinics throughout 9/1/2021-4/30/2022, there were 218 TD referrals. Video visits occurred on average 7.5 ± 0.5 days after referral and 18/18 patients completing the post-visit survey were satisfied. Adoption varied between clinics, with one placing 22% of all dermatology referrals as TD and another placing 2%. The primary PCP barriers to TD were time burdens, lack of fit in clinic flow, and discomfort with image taking. Top-endorsed potential facilitating interventions included allowing for rash referrals without dermoscopy and assurance for clinical evaluation within 3 days. CONCLUSIONS The use of implementation science frameworks allowed for identification of system and contextual strengths which informed the hybrid TD pilot. Barriers and facilitating interventions will provide guidance for expansion and ongoing maintenance of TD.
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Affiliation(s)
- Meenal K Kheterpal
- Department of Dermatology, Duke University Medical Center, DUMC Box 3135, Durham, NC, 27710, USA.
| | - Ethan D Borre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - Matilda W Nicholas
- Department of Dermatology, Duke University Medical Center, DUMC Box 3135, Durham, NC, 27710, USA
| | - Edward W Cooner
- Duke Primary Care, Duke University School of Medicine, Durham, NC, USA
| | - Donna Phinney
- Duke Telehealth Office, Duke University Health System, Durham, NC, USA
| | - Kelly Gagnon
- Performance Services, Duke University Health System, Durham, NC, USA
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
| | - Heather A King
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Elizabeth J Malcolm
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Suephy C Chen
- Department of Dermatology, Duke University Medical Center, DUMC Box 3135, Durham, NC, 27710, USA
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Maul LV, Jahn AS, Pamplona GSP, Streit M, Gantenbein L, Müller S, Nielsen ML, Greis C, Navarini AA, Maul JT. Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology. JMIR DERMATOLOGY 2023; 6:e45384. [PMID: 37582265 PMCID: PMC10457706 DOI: 10.2196/45384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/15/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. OBJECTIVE The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. METHODS This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. RESULTS Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). CONCLUSIONS This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. TRIAL REGISTRATION ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036.
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Affiliation(s)
- Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Anna Sophie Jahn
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Gustavo S P Pamplona
- Jules-Gonin Eye Hospital/Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Markus Streit
- Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorena Gantenbein
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mia-Louise Nielsen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Christian Greis
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Kheterpal M, Borre ED, Nicholas MW, Cooner EW, Phinney D, Gagnon K, Zullig LL, King HA, Malcolm EJ, Chen SC. Implementation Evaluation of a Teledermatology Virtual Clinic at an Academic Medical Center. RESEARCH SQUARE 2023:rs.3.rs-2558425. [PMID: 36909611 PMCID: PMC10002841 DOI: 10.21203/rs.3.rs-2558425/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background Teledermatology (TD) is an evidence-based practice that may increase access to dermatologic care. We sought to evaluate implementation of TD at four Duke primary care practices. Methods We implemented a hybrid TD program where trained primary care providers (PCPs) sent referrals with clinical and dermatoscopic images to dermatology. Patients were seen by dermatologists over video visit within days, and dermatologists managed the patient plan. We evaluated implementation using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework using electronic health record data. Implementation barriers and facilitators were collected through surveys (n = 24 PCPs, n = 10 dermatologists, n = 10 dermatology residents). Results At four PCP clinics throughout 9/1/2021-4/30/2022 there were 218 TD referrals. Video visits occurred on average 7.5 days after referral and 18/18 patients completing the post-visit survey were satisfied. Adoption varied between clinics, with one placing 22% of all dermatology referrals as TD and another placing 2%. The primary PCP barriers to TD were time burdens, lack of fit in clinic flow, and discomfort with image taking. Top-endorsed potential facilitating interventions included allowing for rash referrals without dermoscopy and assurance for clinical evaluation within 3 days. Conclusions Addressing TD process fit into PCP clinic flow and reducing time burdens may increase PCP uptake of TD.
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Pachito DV, de Azeredo-da-Silva ALF, de Oliveira PRBP, Bagattini ÂM, Basso J, Gehres LG, Mallmann ÉDB, Rodrigues ÁS, Riera R, Gadenz SD. Telehealth Strategies to Support Referral Management to Secondary Care in Brazil: A Cost-Effectiveness Analysis. Value Health Reg Issues 2022; 31:74-80. [PMID: 35568011 DOI: 10.1016/j.vhri.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to assess the cost-effectiveness of a remotely operated referral management system (RORMS) compared with a conventional referral management system (CRMS) in Brazil. METHODS This is a model-based cost-effectiveness analysis under the perspective of the Unified Healthcare System (Sistema Único de Saúde [SUS]) in Brazil. A Markov microsimulation model was developed to compare costs and referral outcomes of the RORMS and the CRMS. Model consisted of 4 states representative of sequential stepwise assessments of referral suitability, 3 states representative of referral outcomes, and 1 exit model state. Target population represented cases being referred from primary healthcare units to specialized care in SUS. Model inputs related to costs and effectiveness in the RORMS arm were obtained from the data set of a RORMS between July and December 2019. Model inputs for the CRMS model arm were obtained from administrative data sets of 2 Brazilian localities for the year 2019. Relative effect size of RORMS in comparison with CRMS in SUS was obtained from published studies. Effectiveness outcome was unnecessary referrals averted. The incremental cost-effectiveness ratio was calculated for the base case. Probabilistic sensitivity analysis was conducted. RESULTS In the base-case analyses, RORMS dominated CRMS, with expected cost-savings from $50.42 to $80.62 per unnecessary referral averted. RORMS was the dominant strategy in 83.7% of 100 000 simulations in the probabilistic sensitivity analysis. In 16.2% of simulations, incremental cost-effectiveness ratio was between $0 and $222 per unnecessary referral averted. CONCLUSIONS Model-based simulations indicate that the RORMS is likely to be cost saving in comparison with the CRMS.
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Affiliation(s)
| | | | | | | | - Josué Basso
- Regula Mais Brasil, Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | - Átila S Rodrigues
- Ministry of Health, Brazil; Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Rachel Riera
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital Sírio-Libanês, São Paulo, Brazil
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Palamaras I, Wark H, Short B, Hameed OA, Sheraz AA, Thomson P, Kalirai K, Rose L. Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK. J Vis Commun Med 2021; 45:6-17. [PMID: 34854359 DOI: 10.1080/17453054.2021.2004883] [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: 10/19/2022]
Abstract
A new, store-and-forward, fully digitised Teledermatology (TD) pathway was designed and implemented in an urban setting for non-two-week wait routine patients. In total 8,352 new patients had a TD consultation over 37 months. Of these, 4,748 (56.8%) were referred back to their GP, 1,634 (19.6%) were referred directly for a surgical procedure and 1,970 (23.6%) for a face-to-face review with a Dermatologist (F2F). The average waiting time for a TD appointment was 3 vs. 30 weeks for a routine F2F appointment. Between 2019 and 2018, TD referrals rose by 38%, routine dermatology referrals reduced by 16% and cancer referrals increased by 6%. Using medical photographers proved to be effective with only two cases (0.02%) of images being of insufficient quality to form a clinical opinion. Hitherto, savings for the local Commissioning Groups were estimated at £671,218. Last financial year savings (2019-2020) were £284,671. The average cost savings per TD patient appointment was £80.36. Savings in the Trust's overhead costs were £53,587. TD consultants reviewed almost twice the number of patients vs. F2F for the same amount of consultant programmed activities. 95% of surveyed patients would be likely or extremely likely to recommend this service to friends and family.
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Affiliation(s)
- Ioulios Palamaras
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Helen Wark
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Billy Short
- Royal Free London NHS Foundation Trust, Cerner, London, United Kingdom of Great Britain and Northern Ireland
| | - Omair Akhtar Hameed
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Adil Ahmed Sheraz
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Penelope Thomson
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
| | - Kam Kalirai
- Royal Free London NHS Foundation Trust, Clinical Practice Group (CPG), London, United Kingdom of Great Britain and Northern Ireland
| | - Lisa Rose
- Royal Free London NHS Foundation Trust, Dermatology, London, United Kingdom of Great Britain and Northern Ireland
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Veremu M, Sohail A, McMaster D. COVID-19: exploring out-of-hospital solutions to increased service demand. Fam Pract 2021; 38:694-695. [PMID: 33904922 PMCID: PMC8135500 DOI: 10.1093/fampra/cmab032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Munashe Veremu
- School of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Victoria, Malta
| | - Ali Sohail
- School of Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Victoria, Malta
| | - David McMaster
- School of Medicine, University of Nottingham, Nottingham, UK
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Assis Acurcio FD, Guerra Junior AA, Marino Calvo MC, Nunes DH, Akerman M, Spinel LF, Garcia MM, Pereira RG, Costa Borysow ID, Silva RR, Azevedo PS, Iacabo Correia Gomes PC, Alvares-Teodoro J. Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System. J Comp Eff Res 2021; 10:1159-1168. [PMID: 34494888 DOI: 10.2217/cer-2021-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients' access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.
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Affiliation(s)
- Francisco de Assis Acurcio
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Augusto Afonso Guerra Junior
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Maria Cristina Marino Calvo
- Centro de Ciências da Saúde - Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Daniel Holthausen Nunes
- Serviço de Dermatologia, Hospital Universitário Polyodoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis, Brasil
| | - Marco Akerman
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | | | - Marina Morgado Garcia
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | - Ramon Gonçalves Pereira
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | - Pamela Santos Azevedo
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | - Juliana Alvares-Teodoro
- Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde - Departamento de Farmácia Social, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
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Wu LW, Cho SK, Chamseddin B, Ashworth J, Hynan LS, Chong BF, Dominguez AR. Evaluation of the effect of store-and-forward teledermatology on in-person health care system utilization in a safety-net public health and hospital system. J Am Acad Dermatol 2021; 85:1026-1028. [PMID: 33482252 DOI: 10.1016/j.jaad.2020.12.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Lawrence W Wu
- University of Texas Southwestern Medical School, Dallas, Texas
| | - Sung K Cho
- University of Texas Southwestern Medical School, Dallas, Texas
| | | | - John Ashworth
- Office of Decision Support, Parkland Health and Hospital System, Dallas, Texas
| | - Linda S Hynan
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Zakaria A, Miclau TA, Maurer T, Leslie KS, Amerson E. Cost Minimization Analysis of a Teledermatology Triage System in a Managed Care Setting. JAMA Dermatol 2021; 157:52-58. [PMID: 33206146 PMCID: PMC7675221 DOI: 10.1001/jamadermatol.2020.4066] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/19/2020] [Indexed: 11/14/2022]
Abstract
Importance Teledermatology (TD) enables remote triage and management of dermatology patients. Previous analyses of TD systems have demonstrated improved access to care but an inconsistent fiscal impact. Objective To compare the organizationwide cost of managing newly referred dermatology patients within a TD triage system vs a conventional dermatology care model at the Zuckerberg San Francisco General Hospital and Trauma Center (hereafter referred to as the ZSFG) in California. Design, Setting, and Participants A retrospective cost minimization analysis was conducted of 2098 patients referred to the dermatology department at the ZSFG between June 1 and December 31, 2017. Intervention Implementation of the TD triage system in January 2015. Main Outcomes and Measures The main outcome was mean cost to the health care organization to manage newly referred dermatology patients with or without TD triage. To estimate costs, decision-tree models were constructed to characterize possible care paths with TD triage and within a conventional dermatology care model. Costs associated with primary care visits, dermatology visits, and TD visits were then applied to the decision-tree models to estimate the mean cost of managing patients following each care path for 6 months. The mean cost for each visit type incorporated personnel costs, with the mean cost per TD consultation also incorporating software implementation and maintenance costs. Finally, ZSFG patient data were applied within the models to evaluate branch probabilities, enabling calculation of mean cost per patient within each model. Results The analysis captured 2098 patients (1154 men [55.0%]; mean [SD] age, 53.4 [16.8] years), with 1099 (52.4%) having Medi-Cal insurance and 879 (41.9%) identifying as non-White. In the decision-tree model with TD triage, the mean (SD) cost per patient to the health care organization was $559.84 ($319.29). In the decision-tree model for conventional dermatology care, the mean (SD) cost per patient was $699.96 ($390.24). Therefore, the TD model demonstrated a statistically significant mean (SE) cost savings of $140.12 ($11.01) per patient. Given an annual dermatology referral volume of 3150 patients, the analysis estimates an annual savings of $441 378. Conclusions and Relevance Implementation of a TD triage system within the dermatology department at the ZSFG was associated with cost savings, suggesting that managed health care settings may experience significant cost savings from using TD to triage and manage patients.
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Affiliation(s)
- Adam Zakaria
- Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Theodore A. Miclau
- Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Toby Maurer
- Department of Dermatology, Indiana University, Indianapolis
| | - Kieron S. Leslie
- Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
| | - Erin Amerson
- Department of Dermatology, University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco
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Needs, barriers and facilitators of older adults towards eHealth in general practice: a qualitative study. Prim Health Care Res Dev 2020; 21:e54. [PMID: 33263272 PMCID: PMC7737186 DOI: 10.1017/s1463423620000547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The strain on health care services is increasing due to an ageing population and the increasing prevalence of chronic health conditions. eHealth could contribute to optimise effective and efficient care to older adults with one or more chronic health conditions in the general practice. Aim: The aim of this study was to identify the needs, barriers and facilitators amongst community-dwelling older adults (60+) suffering from one or more chronic health conditions, in using online eHealth applications to support general practice services. Methods: A qualitative study, using semi-structured followed by think-aloud interviews, was conducted in the Netherlands. The semi-structured interviews, supported by an interview guide were conducted and analysed thematically. The think-aloud method was used to collect data about the cognitive process while the participant was completing a task within online eHealth applications. Verbal analysis according to the Chi approach was conducted to analyse the think-aloud interviews. Findings: A total of n = 19 older adults with a mean age of 73 years participated. The ability to have immediate contact with the GP on important health issues was identified as an important need. Identified barriers were non-familiarity with the online eHealth applications and a mismatch of user health needs. The low computer experience resulted in non-familiarity with the online eHealth applications. Faltering applications resulted in participants refusing to participate in the use of online eHealth applications. Convenience, efficiency and the instant availability of eHealth via applications were identified as important facilitators. Conclusion: To improve the use and acceptability of eHealth applications amongst older adults in the general practice, the applications should be tailored to meet individual needs. More attention should be given to improving the user-friendliness of these applications and to the promotion of the benefits such as facilitating older adults independent living for longer.
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Hadeler E, Gitlow H, Nouri K. Definitions, survey methods, and findings of patient satisfaction studies in teledermatology: a systematic review. Arch Dermatol Res 2020; 313:205-215. [PMID: 32725501 PMCID: PMC7385477 DOI: 10.1007/s00403-020-02110-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
Remote consultations likely will grow in importance if the COVID-19 pandemic continues. This review analyzes which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys and concluded patients respond to the different modalities of teledermatology. Using PubMed and Cochrane databases, we reviewed studies from April 5th, 2010 to April 5th, 2020 that included the search terms patient satisfaction and teledermatology. All studies that included patient satisfaction as an outcome were included, but studies not published in English were excluded. We examined domains of satisfaction, survey method, study characteristics (including patient population, country, age, study design and evidence score), findings and statistical comparisons. We thoroughly reviewed 23 studies. Definitions of satisfaction varied, but all concluded patients were satisfied with the live-interactive and store-and-forward modalities. The studies reveal that store-and-forward is appropriate for clinicians with established patients who require regular follow-up. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring, and post-procedural follow-up. Only four studies conducted statistical analyses. One of those studies compared patient preference for each modality of teledermatology with face-to-face dermatology. While this study reported high satisfaction with each mode of teledermatology, patients still preferred face-to-face. Favorable responses to remote diagnostic capabilities suggest that these offerings improve preference for teledermatology. With only one study evaluating preference between each modality and face-to-face dermatology, more studies should address the discrepancy. Surveys that cover all domains of satisfaction may improve assessments and identify where gaps in preference exist.
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Affiliation(s)
- Edward Hadeler
- Miller School of Medicine Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Howard Gitlow
- Herbert Business School, University of Miami, Coral Gables, FL, USA
| | - Keyvan Nouri
- Miller School of Medicine Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
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13
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Primary Care Professionals' Acceptance of Medical Record-Based, Store and Forward Provider-to-Provider Telemedicine in Catalonia: Results of a Web-Based Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114092. [PMID: 32521740 PMCID: PMC7313088 DOI: 10.3390/ijerph17114092] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
While telemedicine services enjoy a high acceptance among the public, evidence regarding clinician’s acceptance, a key factor for sustainable telemedicine services, is mixed. However, telemedicine is generally better accepted by both patients and professionals who live in rural areas, as it can save them significant time. The objective of this study is to assess the acceptance of medical record-based, store and forward provider-to-provider telemedicine among primary care professionals and to describe the factors which may determine their future use. This is an observational cross-sectional study using the Catalan version of the Health Optimum questionnaire; a technology acceptance model-based validated survey comprised of eight short questions. The online, voluntary response poll was sent to all 661 primary care professionals in 17 primary care teams that had potentially used the telemedicine services of the main primary care provider in Catalonia, in the Central Catalan Region. The majority of respondents rated the quality of telemedicine consultations as “Excellent” or “Good” (83%). However, nearly 60% stated that they sometimes had technical, organizational or other difficulties, which might affect the quality of care delivered. These negatively predicted their declared future use (p = 0.001). The quality of telemedicine services is perceived as good overall for all the parameters studied, especially among nurses. It is important that policymakers examine and provide solutions for the technical and organizational difficulties detected (e.g., by providing training), in order to ensure the use of these services in the future.
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Gilling S, Mortz CG, Vestergaard T. Patient Satisfaction and Expectations Regarding Mobile Teledermoscopy in General Practice for Diagnosis of Non-melanoma Skin Cancer and Malignant Melanoma. Acta Derm Venereol 2020; 100:adv00117. [PMID: 32179927 PMCID: PMC9128923 DOI: 10.2340/00015555-3459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2010] [Indexed: 11/16/2022] Open
Abstract
The incidence of non-melanoma skin cancer and malignant melanoma is increasing. Diagnosing these skin lesions is primarily done visually, making it suitable to use new technology, such as teledermoscopy. Before the implementation of teledermoscopy, patient satisfaction, clinician satisfaction and diagnostic accuracy, need to be evaluated. A cross-sectional quantitative survey was conducted to evaluate patient satisfaction and expectations regarding a mobile teledermoscopy service, and to identify factors influencing patient satisfaction and choice of diagnostic method. A total of 287 out of 476 participants responded to the questionnaire. Almost 90% of respondents were satisfied with, or neutral towards, teledermoscopy. No associations between patient satisfaction and age, smartphone/tablet usage, travel time, prior history of non-melanoma skin cancer and malignant melanoma, or worries about malignancy, were found. There was equal distribution between patients who preferred teledermoscopy and those who preferred face-to-face consultation. Respondents with a high level of smartphone usage significantly preferred teledermoscopy.
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Affiliation(s)
- Sofie Gilling
- Faculty of Health Sciences, University of Southern Denmark, DK-5000 Odense, Denmark.
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15
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Nicholson P, Macedo C, Fuller C, Thomas L. Patient satisfaction with a new skin cancer teledermatology service. Clin Exp Dermatol 2020; 45:691-698. [DOI: 10.1111/ced.14191] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/18/2020] [Accepted: 02/04/2020] [Indexed: 12/24/2022]
Affiliation(s)
- P. Nicholson
- Dermatology Department Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - C. Macedo
- Dermatology Department Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - C. Fuller
- Dermatology Department Chelsea and Westminster Hospital NHS Foundation Trust London UK
| | - L. Thomas
- Dermatology Department Chelsea and Westminster Hospital NHS Foundation Trust London UK
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16
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Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol 2020; 83:299-307. [PMID: 32035106 DOI: 10.1016/j.jaad.2020.01.065] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.
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Affiliation(s)
- Robin H Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Stavert
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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17
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Coustasse A, Sarkar R, Abodunde B, Metzger BJ, Slater CM. Use of Teledermatology to Improve Dermatological Access in Rural Areas. Telemed J E Health 2019; 25:1022-1032. [PMID: 30741608 DOI: 10.1089/tmj.2018.0130] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Raghav Sarkar
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Brandon J. Metzger
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Chelsea M. Slater
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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Jones OT, Jurascheck LC, van Melle MA, Hickman S, Burrows NP, Hall PN, Emery J, Walter FM. Dermoscopy for melanoma detection and triage in primary care: a systematic review. BMJ Open 2019; 9:e027529. [PMID: 31434767 PMCID: PMC6707687 DOI: 10.1136/bmjopen-2018-027529] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Most skin lesions first present in primary care, where distinguishing rare melanomas from benign lesions can be challenging. Dermoscopy improves diagnostic accuracy among specialists and is promoted for use by primary care physicians (PCPs). However, when used by untrained clinicians, accuracy may be no better than visual inspection. This study aimed to undertake a systematic review of literature reporting use of dermoscopy to triage suspicious skin lesions in primary care settings, and challenges for implementation. DESIGN A systematic literature review and narrative synthesis. DATA SOURCES We searched MEDLINE, Cochrane Central, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and SCOPUS bibliographic databases from 1 January 1990 to 31 December 2017, without language restrictions. INCLUSION CRITERIA Studies including assessment of dermoscopy accuracy, acceptability to patients and PCPs, training requirements, and cost-effectiveness of dermoscopy modes in primary care, including trials, diagnostic accuracy and acceptability studies. RESULTS 23 studies met the review criteria, representing 49 769 lesions and 3708 PCPs, all from high-income countries. There was a paucity of studies set truly in primary care and the outcomes measured were diverse. The heterogeneity therefore made meta-analysis unfeasible; the data were synthesised through narrative review. Dermoscopy, with appropriate training, was associated with improved diagnostic accuracy for melanoma and benign lesions, and reduced unnecessary excisions and referrals. Teledermoscopy-based referral systems improved triage accuracy. Only three studies examined cost-effectiveness; hence, there was insufficient evidence to draw conclusions. Costs, training and time requirements were considered important implementation barriers. Patient satisfaction was seldom assessed. Computer-aided dermoscopy and other technological advances have not yet been tested in primary care. CONCLUSIONS Dermoscopy could help PCPs triage suspicious lesions for biopsy, urgent referral or reassurance. However, it will be important to establish further evidence on minimum training requirements to reach competence, as well as the cost-effectiveness and patient acceptability of implementing dermoscopy in primary care. TRIAL REGISTRATION NUMBER CRD42018091395.
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Affiliation(s)
- O T Jones
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - L C Jurascheck
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A van Melle
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S Hickman
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - N P Burrows
- Addenbrooke's Hospital Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - P N Hall
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Emery
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - F M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- General Practice and Primary Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
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19
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Peracca SB, Jackson GL, Weinstock MA, Oh DH. Implementation of Teledermatology: Theory and Practice. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Liaw WR, Jetty A, Coffman M, Petterson S, Moore MA, Sridhar G, Gordon AS, Stephenson JJ, Adamson W, Bazemore AW. Disconnected: a survey of users and nonusers of telehealth and their use of primary care. J Am Med Inform Assoc 2019; 26:420-428. [PMID: 30865777 PMCID: PMC7787350 DOI: 10.1093/jamia/ocy182] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/21/2018] [Accepted: 12/01/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study sought to assess awareness, perceptions, and value of telehealth in primary care from the perspective of patients. MATERIALS AND METHODS We conducted a cross-sectional, Web-based survey of adults with access to telehealth services who visited healthcare providers for any of the 20 most-commonly seen diagnoses during telehealth visits. Three groups were studied: registered users (RUs) of telehealth had completed a LiveHealth Online (a health plan telehealth service provider) visit, registered nonusers (RNUs) registered for LiveHealth Online but had not conducted a visit, and nonregistered nonusers (NRNUs) completed neither step. RESULTS Of 32 831 patients invited, 3219 (9.8%) responded and 766 met eligibility criteria and completed surveys: 390 (51%) RUs, 117 (15%) RNUs, and 259 (34%) NRNUs. RUs were least likely to have a primary care usual source of care (65.6% vs 78.6% for RNUs vs 80.0% for NRNUs; P < .001). Nearly half (46.8%) of RUs were unable to get an appointment with their doctor, and 34.8% indicated that their doctor's office was closed. Among the 3 groups, RUs were most likely to be employed (89.5% vs 88.9% vs 82.2%; P = .007), have post-high school education (94.4% vs 93.2% vs 86.5%; P = .003), and live in urban areas (81.0% vs 69.2% vs 76.0%; P = .021). CONCLUSIONS Telehealth users reported that they relied on live video for enhanced access and were less connected to primary care than nonusers were. Telehealth may expand service access but risks further fragmentation of care and undermining of the primary care function absent better coordination and information sharing with usual sources of patients' care.
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Affiliation(s)
- Winston R Liaw
- Robert Graham Center, Washington, DC, USA
- Department of Health Systems and Population Health Sciences, College of Medicine, University of Houston, Houston, Texas, USA
| | | | | | | | - Miranda A Moore
- Department of Family & Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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21
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Mehrtens SH, Shall L, Halpern SM. A 14-year review of a UK teledermatology service: experience of over 40 000 teleconsultations. Clin Exp Dermatol 2019; 44:874-881. [PMID: 30767255 DOI: 10.1111/ced.13928] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in-house TD service using store-and-forward technology was set up at a large regional dermatology department in 2004. AIM To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes. METHODS Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback. RESULTS In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face-to-face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance. CONCLUSIONS We have set up a successful TD service at a UK centre, which has prevented 16 282 face-to-face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
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Affiliation(s)
- S H Mehrtens
- Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - L Shall
- Medway NHS Foundation Trust, Gillingham, Kent, UK
| | - S M Halpern
- Medway NHS Foundation Trust, Gillingham, Kent, UK
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Marwaha SS, Fevrier H, Alexeeff S, Crowley E, Haiman M, Pham N, Tuerk MJ, Wukda D, Hartmann M, Herrinton LJ. Comparative effectiveness study of face-to-face and teledermatology workflows for diagnosing skin cancer. J Am Acad Dermatol 2019; 81:1099-1106. [PMID: 30738843 DOI: 10.1016/j.jaad.2019.01.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 01/11/2019] [Accepted: 01/19/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND The effectiveness and value of teledermatology and face-to-face workflows for diagnosing lesions are not adequately understood. OBJECTIVE We compared the risks of biopsy and cancer diagnosis among 2 face-to-face workflows (direct referral and roving dermatologist) and 4 teledermatology workflows. METHODS Retrospective study of 59,279 primary care patients presenting with a lesion from January through June 2017. RESULTS One teledermatology workflow achieved high-resolution images with use of a dermatoscope-fitted digital camera, a picture archiving and communication system, and image retrieval to a large computer monitor (in contrast to a smartphone screen). Compared with direct referral, this workflow was associated with a 9% greater probability of cancer detection (95% confidence interval [CI], 2%-16%), a 4% lower probability of biopsy (relative risk, 0.96; 95% CI, 0.93-0.99), and 39% fewer face-to-face visits (relative risk, 0.61; 95% CI, 0.57-0.65). Other workflows were less effective. LIMITATIONS Differing proficiencies across teledermatology workflows and selection of patients for direct referral could have caused bias. CONCLUSION Implementation is critical to the effectiveness of teledermatology.
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Affiliation(s)
| | - Helene Fevrier
- Division of Research, Kaiser Permanente, Oakland, California
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente, Oakland, California
| | | | | | - Ngoc Pham
- Dermatology, Kaiser Permanente, Santa Clara, California
| | | | - Danny Wukda
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, California
| | - Michael Hartmann
- The Permanente Medical Group, Quality and Operations Support, Kaiser Permanente, Oakland, California
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Janda M, Horsham C, Koh U, Gillespie N, Vagenas D, Loescher LJ, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Peter Soyer H. Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer. Digit Health 2019; 5:2055207619828225. [PMID: 30792879 PMCID: PMC6376520 DOI: 10.1177/2055207619828225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the study is to evaluate healthcare practitioners’ views on and
satisfaction with (i) digital image acquisition and storage and (ii)
store-and-forward teledermoscopy services for the diagnosis of skin cancer
in their clinical practice. Methods An online survey was conducted among 59 healthcare practitioners (GPs
(n=17), dermatologists (n=22),
dermatology registrars (n=18), a dermatology research
fellow (n=1) and a plastic surgeon (n=1))
to assess usability of digital image acquisition and storage for when the
imaging process is conducted by the healthcare practitioners themselves, or
by their patients. The study identifies the enablers and barriers of this
emerging mode of medical practice. A thematic analysis was used to extract
key themes from open-ended responses, which involved identifying themes and
patterns within and across participants. Results Thirty-four healthcare practitioners (58%) had previously used a mobile
dermatoscope within their practice. Participants most appreciated its use in
their practice for lesion monitoring (59%) and record keeping (39%).
Challenges reported were the increased time to support the additional
workload (45%), technical issues (33%) and cost of equipment (27%).
Practitioners were unsure (36%) or did not advocate teledermoscopy for
direct-to-consumer use (41%). Only 23% supported the use of
direct-to-consumer teledermoscopy. Conclusion While most practitioners are receptive to mobile teledermoscopy, there was
less support for patient-initiated use, whereby the patient controls the
imaging process. As technology improves rapidly it is important to evaluate
practitioners’ acceptance and satisfaction of evolving telehealth services,
moving forward with models of practice where healthcare practitioners and
other healthcare providers will feel comfortable engaging in telehealth
services.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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Pilot Teledermatology Service for Assessing Solitary Skin Lesions in a Tertiary London Dermatology Center. J Healthc Qual 2019; 41:e1-e6. [DOI: 10.1097/jhq.0000000000000142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F, Mendioroz Peña J, Flores Mateo G, Deniel Rosanas J, Sauch Valmaña G. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv Res 2018; 18:650. [PMID: 30134891 PMCID: PMC6103877 DOI: 10.1186/s12913-018-3464-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A teledermatology pilot scheme was first conducted in the town of Manresa (Barcelona) in the summer of 2010. The clinical success of the scheme prompted its expansion to the whole county of Bages in 2011 and to the adjacent county of Berguedà in 2012. In the teledermatology service, primary care physicians take a photograph of the lesion and attach it to the electronic medical records of the patient together with a brief clinical account. In the referral hospital, the consultant dermatologists access the electronic medical records, review the images and suggest a treatment or action plan. Next, the primary care physicians review these recommendations and call the patient to report the results. This whole process is usually completed in less than 5 working days. METHODS A cost saving analysis comparing teledermatology with dermatology face-to-face visits was performed in the county of Bages measuring the cost difference attributable to visits saved. RESULTS The estimated added costs of the teledermatology service during 2016 amounted to 61,870 €. For the same period, the estimated costs of traditional outpatient dermatology services were of 113,034 €. This represents savings of 51,164 € per year. After subtraction of societal costs, the savings equal 10,350 € per year. CONCLUSIONS Using a teledermatology service instead of face-to-face dermatology consultations could save 51,164 € per year (11.4 € per patient visited) in the county of Bages. Societal savings are the most significant.
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Affiliation(s)
- Josep Vidal-Alaball
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain.
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
- Department of Economics and Business, University of Vic- Central University of Catalonia, Vic, Barcelona, Spain.
| | - Josep Lluís Garcia Domingo
- Department of Economics and Business, University of Vic- Central University of Catalonia, Vic, Barcelona, Spain
| | - Francesc Garcia Cuyàs
- General Surgery Department, Autonomous University of Barcelona, Barcelona, Spain
- Chair in ICT and Healthcare, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Jacobo Mendioroz Peña
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | | | - Joan Deniel Rosanas
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Glòria Sauch Valmaña
- Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Carrer Pica d'Estats, 36, 08272, Sant Fruitós de Bages, Barcelona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
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Lee KJ, Finnane A, Soyer HP. Recent trends in teledermatology and teledermoscopy. Dermatol Pract Concept 2018; 8:214-223. [PMID: 30116667 PMCID: PMC6092076 DOI: 10.5826/dpc.0803a13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/21/2018] [Indexed: 11/28/2022] Open
Abstract
Teledermatology is a useful alternative where specialized dermatological assistance is not available and has been used successfully to support health professionals in a wide range of settings worldwide, in either an asynchronous store-and-forward format or a real-time video conferencing format. Teledermoscopy, which includes dermoscopic images in the teleconsultation, is another addition that improves remote assessments of pigmented lesions. A more recent variant is mobile teledermoscopy, which uses a smartphone to deliver the same type of service. Teledermoscopy’s greatest strength may be as a triage and monitoring tool, as it can reduce the number of unnecessary referrals, wait times, and the cost of providing and receiving dermatological care. While face-to-face (FTF) care remains the gold standard for diagnosis, drawbacks of not using FTF care as the primary method can be mitigated if teleconsultants are willing to refer to FTF care whenever there is uncertainty. Teledermatology has generally been well accepted by patients and practitioners alike. Barriers to the large-scale use of teledermatology remain. Assigning medicolegal responsibility and instituting a reimbursement system are critical to promoting widespread use by medical professionals, while privacy and security features and a mechanism to link teleconsultations to patients’ existing health records are essential to maximize patient benefit. Direct-to-consumer services also need attention from regulators to ensure that consumers can enjoy the benefits of telemedicine without the dangers of unregulated or untested platforms.
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Affiliation(s)
- Katie J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia
| | - Anna Finnane
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,The University of Queensland, School of Public Health, Herston, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
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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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28
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Ehrlich A, Kostecki J, Olkaba H. Trends in dermatology practices and the implications for the workforce. J Am Acad Dermatol 2017; 77:746-752. [DOI: 10.1016/j.jaad.2017.06.030] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 11/24/2022]
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Marchell R, Locatis C, Burgess G, Maisiak R, Liu WL, Ackerman M. Patient and Provider Satisfaction with Teledermatology. Telemed J E Health 2017; 23:684-690. [PMID: 28375822 PMCID: PMC5564023 DOI: 10.1089/tmj.2016.0192] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is little research comparing dermatologist and patient satisfaction with in-person, store-and-forward, and live interactive examinations. OBJECTIVE To compare satisfaction with in-person examinations to store-and-forward and live interactive consultations having two types of video. METHODS A controlled study was conducted where patients referred for dermatology consultations were examined in-person, by video, and by store-and-forward methods. Video changed between compressed and uncompressed on alternate clinics. Patients and dermatologists rated encounters after each examination. Dermatologists doing store-and-forward evaluations rated the quality of information provided. After experiencing all methods patients ranked their preferences. Dermatologists ranked their preferences at the end of the study. RESULTS In-person examinations were preferred by both patients and dermatologists. Overall, satisfaction with teledermatology was still high. Patients were evenly divided in preferring store-and-forward workups or live interactive video. Dermatologists were also divided on store-and-forward and uncompressed video, but tended toward the latter. Compressed video was the least preferred method among dermatologists. LIMITATIONS Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice. CONCLUSIONS Patients and dermatologists prefer in-person examinations and diverge on preferring store-and-forward and live interactive when video is not compressed. The amount of video compression that can be applied without noticeable image degradation is a question for future research.
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Affiliation(s)
- Richard Marchell
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Craig Locatis
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Gene Burgess
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Wei-Li Liu
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Michael Ackerman
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
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31
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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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A Systematic Review of the Use of Telemedicine in Plastic and Reconstructive Surgery and Dermatology. Ann Plast Surg 2017; 78:736-768. [DOI: 10.1097/sap.0000000000001044] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Mounessa JS, Chapman S, Braunberger T, Qin R, Lipoff JB, Dellavalle RP, Dunnick CA. A systematic review of satisfaction with teledermatology. J Telemed Telecare 2017; 24:263-270. [PMID: 28350281 DOI: 10.1177/1357633x17696587] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The two most commonly used modalities of teledermatology (TD) are store-and-forward (SF) and live-interactive (LI) TD. Existing studies have not compared these tools with respect to patient and provider satisfaction. Objective To systematically review all published studies of patient and provider satisfaction with SF and LI TD. Methods PubMed, EMBASE, and Cochrane databases were systematically searched for studies on provider or patient satisfaction with SF or LI TD between January 2000 and June 2016. Results Forty eligible studies were identified: 32 with SF TD, 10 with LI TD, and 2 evaluating both. With SF TD, 96% of studies assessing patient satisfaction and 82% of studies assessing provider satisfaction demonstrated satisfaction ( n = 24 and 17, respectively). With LI TD, 89% of studies assessing patient satisfaction and all studies assessing provider satisfaction revealed satisfaction (n = 9 and 6, respectively). Conclusion Patients and providers are satisfied with both SF and LI TD. Studies assessing satisfaction with LI have not been conducted in recent years, and have only been conducted in limited geographic patient populations. Further research assessing satisfaction with TD will help address any dissatisfaction with its uses and allow for increased support and funding of future programmes.
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Affiliation(s)
- Jessica S Mounessa
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie Chapman
- 2 Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Rosie Qin
- 4 Duke University School of Medicine, Durham, NC, USA
| | - Jules B Lipoff
- 5 Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert P Dellavalle
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,6 Dermatology Service, Eastern Colorado Health Care System, US; Department of Veteran Affairs, Denver, CO, USA.,7 Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Cory A Dunnick
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,6 Dermatology Service, Eastern Colorado Health Care System, US; Department of Veteran Affairs, Denver, CO, USA
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Ferrándiz L, Ojeda-Vila T, Corrales A, Martín-Gutiérrez FJ, Ruíz-de-Casas A, Galdeano R, Álvarez-Torralba I, Sánchez-Ibáñez F, Domínguez-Toro JM, Encina F, Narbona FJ, Herrerías-Esteban JM, Moreno-Ramírez D. Internet-based skin cancer screening using clinical images alone or in conjunction with dermoscopic images: A randomized teledermoscopy trial. J Am Acad Dermatol 2017; 76:676-682. [PMID: 28089728 DOI: 10.1016/j.jaad.2016.10.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/22/2016] [Accepted: 10/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teledermoscopy involves the use of dermoscopic images for remote consultation and decision-making in skin cancer screening. OBJECTIVE We sought to analyze the potential benefits gained from the addition of dermoscopic images to an internet-based skin cancer screening system. METHODS A randomized clinical trial assessed the diagnostic performance and cost-effectiveness of clinical teleconsultations (CTC) and clinical with dermoscopic teleconsultations. RESULTS A total of 454 patients were enrolled in the trial (nCTC = 226, nclinical with dermoscopic teleconsultation = 228). Teledermoscopy improved sensitivity and specificity (92.86% and 96.24%, respectively) compared with CTC (86.57% and 72.33%, respectively). Correct decisions were made in 94.30% of patients through clinical with dermoscopic teleconsultations and in 79.20% in CTC (P < .001). The only variable associated with an increased likelihood of correct diagnosis was management using teledermoscopy (odds ratio 4.04; 95% confidence interval 2.02-8.09; P < .0001). The cost-effectiveness analysis showed teledermoscopy as the dominant strategy, with a lower cost-effectiveness ratio (65.13 vs 80.84). LIMITATIONS Potentially, a limitation is the establishment of an experienced dermatologist as the gold standard for the in-person evaluation. CONCLUSIONS The addition of dermoscopic images significantly improves the results of an internet-based skin cancer screening system, compared with screening systems based on clinical images alone.
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Affiliation(s)
- Lara Ferrándiz
- Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain.
| | - Teresa Ojeda-Vila
- Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain
| | - Araceli Corrales
- Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain
| | | | - Andrés Ruíz-de-Casas
- Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | | | | | | | - Juan M Herrerías-Esteban
- Information and Communication Technologies Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - David Moreno-Ramírez
- Dermatology Unit and Teledermatology Network, Virgen Macarena University Hospital, Seville, Spain
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35
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McKoy K, Antoniotti NM, Armstrong A, Bashshur R, Bernard J, Bernstein D, Burdick A, Edison K, Goldyne M, Kovarik C, Krupinski EA, Kvedar J, Larkey J, Lee-Keltner I, Lipoff JB, Oh DH, Pak H, Seraly MP, Siegel D, Tejasvi T, Whited J. Practice Guidelines for Teledermatology. Telemed J E Health 2016; 22:981-990. [PMID: 27690203 DOI: 10.1089/tmj.2016.0137] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.
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Affiliation(s)
- Karen McKoy
- 1 Department of Dermatology, Lahey Hospital and Medical Center , Burlington, Massachusetts
- 2 Harvard Medical School , Boston, Massachusetts
| | | | - April Armstrong
- 4 Southern California Clinical and Translational Science Institute (SC CTSI) , Los Angeles, California
- 5 Department of Dermatology, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Rashid Bashshur
- 6 University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Anne Burdick
- 9 University of Miami Miller School of Medicine , Miami, Florida
| | - Karen Edison
- 10 Department of Dermatology, University of Missouri School of Medicine , Colombia , Missouri
- 11 Missouri Telehealth Network, University of Missouri School of Medicine , Colombia , Missouri
- 12 Center for Health Policy, University of Missouri School of Medicine , Colombia , Missouri
| | - Mark Goldyne
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Carrie Kovarik
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Elizabeth A Krupinski
- 15 Department of Radiology and Imaging Sciences, Emory University , Atlanta, Georgia
| | - Joseph Kvedar
- 17 Connected Health, Partners HealthCare , Boston, Massachusetts
| | - Jim Larkey
- 19 Canfield Scientific , Parsippany, New Jersey
| | - Ivy Lee-Keltner
- 21 Department of Dermatology, University of California Los Angeles-Olive View , Los Angeles, California
| | - Jules B Lipoff
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Dennis H Oh
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Hon Pak
- 18 Department of Dermatology, The George Washington University , Washington, DC
| | - Mark P Seraly
- 25 Department of Dermatology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Daniel Siegel
- 20 State University of New York Health Sciences Center at Brooklyn , Brooklyn, New York
| | - Trilokraj Tejasvi
- 22 Department of Dermatology, University of Michigan , Ann Arbor, Michigan
| | - John Whited
- 23 Research and Development, Durham VA Medical Center , Durham, North Carolina
- 24 Department of Medicine, Duke University School of Medicine , Durham, North Carolina
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Kozera EK, Yang A, Murrell DF. Patient and practitioner satisfaction with tele-dermatology including Australia's indigenous population: A systematic review of the literature. Int J Womens Dermatol 2016; 2:70-73. [PMID: 28492013 PMCID: PMC5418871 DOI: 10.1016/j.ijwd.2016.06.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/04/2022] Open
Abstract
Background Australia’s health disparity, combined with evolving technologies, has evoked increasing interest and funding in health services that could address inequities. One such emerging service is tele-medicine. Objective The purpose of this report is to discuss and evaluate the current literature regarding patient and practitioner satisfaction with tele-medicine, and more specifically tele-dermatology. Methods We searched for literature relevant to tele-dermatology use among Australia’s indigenous population. We synthesized the literature in our report and identified elements of tele-dermatology not yet researched. Results Most significantly, all available research is currently based on descriptive studies and there is no validated tool to assess the efficacy of tele-dermatology. Limitations No published research currently exists on the use of tele-dermatology among Australia’s indigenous population. Conclusion A review of the literature shows that tele-dermatology is considered a valuable service, particularly to patients living in rural areas who might not otherwise have access to specialist care.
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Affiliation(s)
- Emily K Kozera
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Poche Institute, Faculty of Medicine, Sydney University, NSW, Australia
| | - Anes Yang
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia.,Poche Institute, Faculty of Medicine, Sydney University, NSW, Australia
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Lofgreen SJ, Ashack K, Burton KA, Dellavalle RP. Mobile Device Use in Dermatologic Patient Care. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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