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Sy W, Bhayana M, Lamb AJ. Atopic Dermatitis Disease Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1447:209-215. [PMID: 38724795 DOI: 10.1007/978-3-031-54513-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
There has been an influx of new educational resources for atopic dermatitis (AD) patients in recent years. The two primary organizations in the United States offering educational materials, online resources, and other forms of support include the National Eczema Association (NEA) and the American Academy of Dermatology (AAD). Educational workshops and interventions have emerged as tools that can deliver comprehensive information on AD, such as symptoms, treatments, and disease management. In regard to these workshops, studies have proven longer interventions to be more effective. Studies have also found multidisciplinary teams, including psychologists, dietitians, and AD specialists, to be more effective in AD treatment and education. Additionally, video-based education was found to be the most effective delivery medium compared to various written modes of education. Given the psychosocial impacts of AD, support groups have been found to improve life quality and decrease disease severity, with age-specific groups offering the greatest benefits. Technology such as social media and smartphones has also improved education. Social media has allowed the rapid exchange of information to wider audiences, but due to its unregulated nature, false information has also been disseminated. Despite this, web-based interventions have still been found to be satisfying, convenient, and effective in increasing treatment awareness. The advent of smartphone applications has provided patients with access to information on AD symptoms and treatment on demand. While the effectiveness of these promising applications hasn't been confirmed by studies, patient provider interactions via smartphone (teledermatology) have been found to be as effective as in-person appointments. This chapter will discuss these different types of emerging resources available to AD patients including educational materials, interventions, support groups, organizational support, and technological resources and their effectiveness.
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Affiliation(s)
- Wayne Sy
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA
| | - Mahima Bhayana
- Department of Dermatology, Howard University School of Medicine, Washington, DC, USA
| | - Angela J Lamb
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA
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Lamkin RP, Peracca SB, Jackson GL, Hines AC, Gifford AL, Lachica O, Li D, Morris IJ, Paiva M, Weinstock MA, Oh DH. Using the RE-AIM framework to assess national teledermatology expansion. FRONTIERS IN HEALTH SERVICES 2023; 3:1217829. [PMID: 37936881 PMCID: PMC10627029 DOI: 10.3389/frhs.2023.1217829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/02/2023] [Indexed: 11/09/2023]
Abstract
Background Teledermatology has been utilized in the United States Department of Veterans Affairs (VA) for decades but continues to have incomplete penetration. VA has funded an initiative to enhance access to dermatology services since 2017 to support asynchronous teledermatology for Veterans living in rural areas. As part of an ongoing evaluation of this program, we assessed the teledermatology activity between the fiscal years 2020 and 2022. We focused on the second cohort of the initiative, comprising six VA facilities and their 54 referral clinics. Methods We studied teledermatology programs at cohort facilities using the reach, effectiveness, adoption, implementation, and maintenance framework. We used a mixed-methods design including annual online reports completed by participating facilities and VA administrative data. When possible, we compared the data from the 3 years of teledermatology funding with the baseline year prior to the start of funding. Findings Reach: Compared with the baseline year, there was a 100% increase in encounters and a 62% increase in patients seen at the funded facilities. Over 500 clinicians and support staff members were trained. Effectiveness: In FY 2022, primary or specialty care clinics affiliated with the funded facilities had more dermatology programs than primary or specialty care clinics across the VA (83% vs. 71% of sites). Adoption: By the end of the funding period, teledermatology constituted 16% of dermatology encounters at the funded facilities compared with 12% nationally. This reflected an increase from 9.2% at the funded facilities and 10.3% nationally prior to the funding period. Implementation: The continued funding for staff and equipment facilitated the expansion to rural areas. Maintenance: By the end of the funding period, all facilities indicated that they had fully implemented their program for patients of targeted primary care providers. The Program Sustainability Index scores generally increased during the funding period. Conclusions Targeted funding to support asynchronous teledermatology implementation for rural Veterans increased its reach, adoption, and implementation, ultimately improving access. Providing program guidance with staffing and training resources can increase the impact of these programs. Ongoing efforts to maintain and increase communication between primary care and dermatology will be needed to sustain success.
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Affiliation(s)
- Rebecca P. Lamkin
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
| | - Sara B. Peracca
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
| | - George L. Jackson
- Center of Innovation to Accelerate Discovery & Practice Transformation (ADAPT), Durham VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Durham, NC, United States
- Peter O'Donnell, Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Aliya C. Hines
- Department of Medicine, Division of Dermatology, John D. Dingell VA Medical Center, United States Department of Veterans Affairs, Detroit, MI, United States
- Department of Dermatology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Allen L. Gifford
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
- Department of Medicine, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- Department of Health, Law, Policy and Management, School of Public Health, Boston University, Boston, MA, United States
| | - Olevie Lachica
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
| | - Donglin Li
- Center for Healthcare Organizational and Implementation Research (CHOIR), VA Boston Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Boston, MA, United States
| | - Isis J. Morris
- Center of Innovation to Accelerate Discovery & Practice Transformation (ADAPT), Durham VA Health Care System, Veterans Health Administration, United States Department of Veterans Affairs, Durham, NC, United States
| | - Marcelo Paiva
- Center for Dermatology, Providence VA Medical Center, United States Department of Veterans Affairs, Providence, RI, United States
| | - Martin A. Weinstock
- Center for Dermatology, Providence VA Medical Center, United States Department of Veterans Affairs, Providence, RI, United States
- Department of Dermatology and Epidemiology, Brown University, Providence, RI, United States
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
| | - Dennis H. Oh
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA, United States
- Office of Connected Care, Department of Veterans Affairs, Washington, DC, United States
- Department of Dermatology, School of Medicine, University of California San Francisco, San Francisco, CA, United States
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Ademuyiwa AO, Nwomeh BC, Poenaru D, Seyi-Olajide JO, Ademuyiwa IY, Odugbemi TO, Abazie O, Ladipo-Ajayi OA, Bankole O, Elebute OA, Okusanya B, Alakaloko FM, Alabi EO, Makanjuola A, Gupta S, Tran T, Onwuka A A, Smith ER, Pius R, Harrison E, Bode CO. Picture Cards Versus Physical Examination: A Proof-of-Concept Study to Improve the SOSAS Survey Tool. J Surg Res 2023; 284:186-192. [PMID: 36580879 DOI: 10.1016/j.jss.2022.11.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed. METHODS We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool. RESULTS Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%. CONCLUSIONS The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.
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Affiliation(s)
- Adesoji O Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tinuola O Odugbemi
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ogechi Abazie
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwaseun A Ladipo-Ajayi
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olumide A Elebute
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Babasola Okusanya
- Dept of Obstetrics and Gynaecology, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Lagos, Nigeria
| | - Felix M Alakaloko
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Eyitayo O Alabi
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayomide Makanjuola
- Department of Orthopaedics and Trauma, Lagos University Teaching Hospital, Lagos, Nigeria; General Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Shailvi Gupta
- Adams Cowley Shock Trauma Centre and University of Maryland Medical System, Baltimore, Maryland
| | - Tu Tran
- University of Minnesota, Minnesota
| | | | - Emily R Smith
- Department of Surgery, Duke University, Duke Global Health Institute, Durham, North Carolina
| | - Riinu Pius
- Department of Surgery, University of Edinburgh, UK
| | | | - Christopher O Bode
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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Jusuf NK, Putra IB, Puteri Rangkuti AD. Assessing Acne Severity: Teledermatology Versus Face to Face Consultations During the COVID-19 Pandemic. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:30-34. [PMID: 36743968 PMCID: PMC9891209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Acne vulgaris is a common skin disorder in pilosebaceous units that is self-limited, especially in adolescents. This disease not only causes permanent physical complications but also psychosocial effects that harm the quality of life. Telemedicine has grown its popularity in recent years, especially during the COVID-19 pandemic. Store and Forward (SAF) teledermatology using digital cameras has also increased patient service satisfaction, promising diagnostic reliability, and clinical outcomes similar to face-to-face visits. OBJECTIVE We sought to compare the severity of acne vulgaris by teledermatology with face-to-face consultations. We also observe the capability of teledermatology in establishing the severity of acne vulgaris. METHODS This study is an observational analytic study with a cross-sectional design involving 105 patients with a diagnosis of acne vulgaris based on inclusion and exclusion criteria. The characteristics of age and sex were recorded. The severity of acne vulgaris was established directly by the resident and teledermatologically by the dermatologist consultant. Teledermatology was carried out based on photo documentation of five facial lesion areas; namely forehead, chin, right cheek, left cheek, and the entire face, along with photos from the history submitted by the resident. An assessment for acne vulgaris severity was carried out based on the classification from the International Consensus Conference on Acne Classification System. This classification divided acne vulgaris as mild, moderate, and severe with an ordinal measuring scale. A compatibility test was also performed to determine the comparison between teledermatology and face-to-face consultations in establishing the severity of acne vulgaris. Comparison of the severity of acne vulgaris was assessed by the kappa value. RESULTS Acne vulgaris was found more common in women (n=71, 67.6%) and those aged 18 to 22 years (n=55, 52.4%). Most of the subjects have moderate severity based on face-to-face consultations and teledermatology examination (n=52 (49.5%) and n=50 (47.6%), respectively). The value of the capability test between teledermatology and face-to-face consultations in comparing the severity of acne vulgaris is 0.611, which means the capability is considered good. CONCLUSION In this study, the teledermatology examination shows good conformity when compared with face-to-face consultations in assessing severity of acne vulgaris.
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Affiliation(s)
- Nelva Karmila Jusuf
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
| | - Imam Budi Putra
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
| | - Anggita Dwi Puteri Rangkuti
- All authors are with the Department of Dermatology and Venereology, Faculty of Medicine, at Universitas Sumatera Utara, Universitas Sumatera Utara Hospital in Medan, Indonesia
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Rizzi E, Vezzoli M, Pegoraro S, Facchin A, Strina V, Daini R. Teleneuropsychology: normative data for the assessment of memory in online settings. Neurol Sci 2023; 44:529-538. [PMID: 36197578 PMCID: PMC9533275 DOI: 10.1007/s10072-022-06426-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has forced significant changes in clinical practice. Psychologists and neuropsychologists had to modify their settings to assess patients' abilities, switching from an in-person modality to a remote setting by using video calling platforms. Consequently, this change brought about the need for new normative data tailored to remote settings. AIM AND METHODS The study aimed to develop normative data for the online assessment of neuropsychological memory tests and to compare it with the published norms obtained in standard settings. Two hundred and four healthy Italian volunteers performed three verbal memory tests through the Google Meet platform: the Digit Span (Backward and Forward), the Rey Auditory Verbal Learning, and the Verbal Paired Associated Learning Test. RESULTS This research provides specific norms that consider the influence of demographic characteristics. Their comparison with published norms shows a medium to high agreement between systems. The present study provides a reference for the clinical use of neuropsychological instruments to assess verbal memory in a remote setting and offers specific recommendations.
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Affiliation(s)
- Ezia Rizzi
- Department of Social and Human Science, University of Salento, Studium 2000, Via di Valesio, 73100 Lecce, Italy ,Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Michela Vezzoli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Sara Pegoraro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alessio Facchin
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Veronica Strina
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Roberta Daini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Paudel V. Patterns and Barriers of Teledermatology in Resource Limited Settings in COVID-19 Pandemic: A Descriptive Cross-sectional Survey of Nepalese Dermatologists. JAAD Int 2022; 7:62-66. [PMID: 35281323 PMCID: PMC8901366 DOI: 10.1016/j.jdin.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Objective Methods Results Limitations Conclusion
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Pokharel S, Poudel S, Agrawal S, Marahatta S. Awareness, acceptability, and satisfaction of teledermatology consultation among social-media users in Nepal. J Cosmet Dermatol 2021; 21:3078-3084. [PMID: 34716752 DOI: 10.1111/jocd.14557] [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: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Teledermatology refers to the use of telecommunication in consulting one's skin problem to a dermatologist at distance. AIMS This study aims to identify the awareness, acceptability, preferred technical tools, willingness to use, comfortability, and satisfaction of teledermatology among social-media users in Nepal. METHODS It was an exploratory cross-sectional study performed on 360 social-media users, subjected to web-based interview based on pretested proforma containing questions to address: awareness of telemedicine, type and tools preferred for teledermatology, willingness to use, comfortability, and satisfaction of teledermatology services. RESULTS Most of the participants (60.8%) were initially unaware of telemedicine. Despite this, the majority (81.9%) were willing to use the services after being aware, mostly during the follow-up (36.6%). Most of the participants (61.1%) preferred the hybrid model for teleconsultation, while mobile was the preferred technical tool (68.1%) mostly because of its compatibility (84.1%) and portability (56.3%). The majority of the participants felt that teledermatology consultation would be beneficial (77.2%) and they mostly preferred it directly from a dermatologist (85.6%). About two-thirds (64.2%) also believed that teledermatology consultation would eliminate the need for a face-to-face consultation. The majority would be comfortable (68.1%) if their skin lesions are photographed and sent to a dermatologist and would be satisfied (62.5%) with the consultations, through Wi-Fi and mobile data both (55.6%), and via Facebook (97.2%) and Viber (70.8%). CONCLUSIONS Despite being unaware of telemedicine, the participants were willing to use teledermatology consultation and thought that they would be comfortable and satisfied with it.
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Affiliation(s)
| | - Sishir Poudel
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sudha Agrawal
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Suchana Marahatta
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
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Felthun JZ, Taylor S, Shulruf B, Allen DW. Empirical analysis comparing the tele-objective structured clinical examination (teleOSCE) and the in-person assessment in Australia. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2021; 18:23. [PMID: 34551510 PMCID: PMC8616724 DOI: 10.3352/jeehp.2021.18.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE It aimed to compare the use of the tele objective structured clinical examination (teleOSCE) with in-person assessment in high-stakes clinical examination so as to determine the impact of the teleOSCE on the assessment undertaken. Discussion follows regarding what skills and domains can effectively be assessed in a teleOSCE. METHODS This study is a retrospective observational analysis. It compares the results achieved by final year medical students in their clinical examination, assessed using the teleOSCE in 2020 (n=285), with those who were examined using the traditional in-person format in 2019 (n=280). The study was undertaken at the University of New South Wales, Australia. RESULTS In the domain of physical examination, students in 2020 scored 0.277 points higher than those in 2019 (mean difference -0.277, P<0.001, effect size 0.332). Across all other domains, there was no significant difference in mean scores between 2019 and 2020. CONCLUSION The teleOSCE does not negatively impact assessment in clinical examination in all domains except physical examination. If the teleOSCE is the future of clinical skills examination, assessment of physical examination will require concomitant workplace-based assessment.
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Affiliation(s)
| | - Silas Taylor
- Office of Medical Education, University of New South Wales, Sydney, Australia
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales, Sydney, Australia
- Centre for Medical and Health Sciences Education, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Digby Wigram Allen
- School of Medicine, The University of New South Wales, Kensington, Australia
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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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Badowski ME, Bente JA, Davis EM, Isaacs D, Lewis L, Martello JL, Pitlick M, Almodóvar AS, Stadler S, Sutton Burke E, Belk M, Tovey A, Kane‐Gill SL. Telehealth and technological applications in
patient‐centered
care: Implications for pharmacy learners and clinical pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Diana Isaacs
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Lindi Lewis
- American College of Clinical Pharmacy Lenexa Kansas USA
| | | | | | | | | | | | - Madeline Belk
- American College of Clinical Pharmacy Lenexa Kansas USA
| | - Amber Tovey
- American College of Clinical Pharmacy Lenexa Kansas USA
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Handa S, Mehta H, Bishnoi A, Vinay K, Mahajan R, Narang T, Kumaran MS, De D, Dogra S, Parsad D. Teledermatology during the COVID-19 pandemic: Experience at a tertiary care centre in North India. Dermatol Ther 2021; 34:e15022. [PMID: 34089561 PMCID: PMC8209945 DOI: 10.1111/dth.15022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teledermatology has evolved as a valuable option to outpatient visits during the current pandemic. We set up a smartphone-based hybrid model of teledermatology services providing direct care to patients at our center. To analyse patient and physician-experience and acceptability for teledermatology over a 6-month-period, along with clinicodemographic profile of patients. METHODOLOGY Single-center, retrospective study conducted from May 20, 2020 to October 31, 2020. Patient satisfaction level for teledermatology was assessed on a 4-point scale and compared with the satisfaction level during their previous physical visits prior to COVID-19 pandemic. A physician assessment form was utilised to record the experience of dermatologists while providing teledermatology services. RESULTS Of 7530 patients registered, a successful consult was provided to 6125 patients (81.34%). Average number of teleconsultations/day rose from 23.60 in May 2020 to 77.96 in October 2020. Mean age of patients availing teledermatology services was 33.60 ± 16.99 years. Average distance to care and travel time were 100.90 ± 171.77 km and 135 ± 222.32 min, respectively. A definitive diagnosis could be ascertained in 5724 patients (93.45%) and in-person visit was recommended to 133 patients (2.2%). Out of 6125 patients, 5229 could be contacted for feedback, 935 (18.18%), 2230 (42.65%), 1749 (33.45%), and 300 patients (5.70%) reported being very satisfied, satisfied, partially satisfied, and unsatisfied, respectively. Of 1914 patients, who had availed in-person OPD facilities prior to the pandemic, 914 patients (49.62%) preferred in-person visits. Of 34 dermatologists surveyed, 88.2% felt comfortable providing teleconsultations and 82.4% felt the need to continue teledermatology services in the upcoming months. CONCLUSIONS Overall, teledermatology is a valid alternative for in-person dermatology visits during the current crisis; helping with initial triage and further patient management. Further refinement of the process could lead to even more acceptability.
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Affiliation(s)
- Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Davinder Parsad
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Trettin B, Danbjørg DB, Andersen F, Feldman S, Agerskov H. Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study. JMIR DERMATOLOGY 2021; 4:e26673. [PMID: 37632817 PMCID: PMC10501531 DOI: 10.2196/26673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients' needs. OBJECTIVE This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. METHODS Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps-plan, act, observe, and reflect-in the methodology of participatory design. RESULTS Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. CONCLUSIONS Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions.
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Affiliation(s)
- Bettina Trettin
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Boe Danbjørg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Flemming Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Private Hospital Molholm, Vejle, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Steven Feldman
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
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Ghani M, Adler C, Yeung H. Patient Factors Associated with Interest in Teledermatology: Cross-sectional Survey. JMIR DERMATOLOGY 2021; 4:e21555. [PMID: 37625162 PMCID: PMC10501513 DOI: 10.2196/21555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/09/2020] [Accepted: 04/17/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Teledermatology is a conduit for patients communicating with dermatologists on the internet, which bypasses in-person visits. It holds promise to address access needs for dermatologic care; however, the interest in using teledermatology is unknown in underserved populations with potential barriers to the use of health care technology. OBJECTIVE This study aimed to characterize the association between demographic characteristics with interest in exchanging digital images or videos of skin lesions with health care providers electronically. METHODS We examined data from the Health Information National Trends Survey (HINTS) 4 cycle 4 (2014) of the National Cancer Institute. HINTS is a cross-sectional, nationally representative household survey conducted annually, which collects information on demographics, perceptions and use of health information, and provides information on how cancer risks are perceived. HINTS 4 cycle 4 had a sample of 3677 participants. We examined the outcome to the question, "how interested are you in exchanging digital images or videos (eg, photos of skin lesions) with a health care provider electronically?" We dichotomized the outcome by a high level of interest (responding with "very") and those who did not have a high level of interest (responding with "somewhat," "a little," or "not at all") in exchanging images or videos. We used a multivariable logistic regression model developed through backwards selection, with all final covariates associated with varying levels of teledermatology use at P<.05. Sensitivity analysis was performed by changing the outcome dichotomy to model those who were "not at all" interested. Two-sided tests were performed with P<.05 considered significant. RESULTS Among 3447 respondents, 888 (weighted prevalence=26.2%) were "very" interested in participating in teledermatology. A higher interest in using teledermatology was associated with a younger age, higher educational attainment, higher household income, internet usage, type of mobile device ownership, history of electronic medical information exchange with a clinician within the past 12 months, and high level of trust in web-based information on cancer (for all, P<.01), but not with the female gender, race or ethnicity, health insurance status, or having a regular medical provider. CONCLUSIONS Modifiable access barriers to teledermatology adoption include trust, experience with teledermatology, and use of health apps. Teledermatology program implementation should address these specific factors within the digital divide to promote equitable access to care across diverse patient populations.
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Affiliation(s)
- Maham Ghani
- City University of New York School of Medicine, City University of New York, New york, NY, United States
| | - Colin Adler
- Department of Dermatology, Emory University School of Medicine, Emory University, Atlanta, GA, United States
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Emory University, Atlanta, GA, United States
- Regional Telehealth Service, Veterans Affairs Veterans Integrated Service Network 7, Decatur, GA, United States
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Tognetti L, Fiorani D, Russo F, Lazzeri L, Trovato E, Flori ML, Moscarella E, Cinotti E, Rubegni P. Teledermatology in 2020: past, present and future perspectives. Ital J Dermatol Venerol 2021; 156:198-212. [PMID: 33960751 DOI: 10.23736/s2784-8671.21.06731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to patients and physicians needs. The present review aimed to summarize all the efforts and experiences carried out in the field of TD and its subspecialties, the evolution and the future perspectives. A literature search was conducted in PubMed and Google Scholar. The state of the art of the "tele-dermo research" included TD and clinical trials, TD/TDS web platforms, TDS and artificial intelligence studies. Finally, the future perspective of TD/TDS in the era of social distancing was discussed. Using TD in specific situations adds several benefits including time-effectiveness of intervention and reduction in the waiting time for the first visit, reduced travel-costs, reduced sanitary costs, equalization of access from patient to specialistic consult. The communication technologies devices currently available can adequately support the growing needs of tele-assistance. A main limit is the current lack of a common clear European regulation for practicing TD, encompassing privacy issues and data management. The pandemic lockdown of 2020 has highlighted the importance of performing TD for all those patient, elderly and/or fragile, where the alternative would be no care at all. Many efforts are needed to develop efficient workflows and TD programs to facilitate the interplay among the different TD actors, along with practice guidelines or position statements.
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Affiliation(s)
- Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy -
| | - Diletta Fiorani
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Filomena Russo
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Laura Lazzeri
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Emanuele Trovato
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Maria L Flori
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Elvira Moscarella
- Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
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Tian PGJ, Harris JR, Seikaly H, Chambers T, Alvarado S, Eurich D. Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan. JMIR Form Res 2021; 5:e17672. [PMID: 33620325 PMCID: PMC7943336 DOI: 10.2196/17672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/04/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. OBJECTIVE As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. METHODS We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. RESULTS The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. CONCLUSIONS Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use. .
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Affiliation(s)
| | - Jeffrey Richard Harris
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Thane Chambers
- University of Alberta Libraries, University of Alberta, Edmonton, AB, Canada
| | - Sara Alvarado
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Madduri S, Chowdhary R, Sethu Reddy S. Telehealth Adoption Among Endocrinologists During The Covid-19 Pandemic. Endocr Pract 2021; 26:846-856. [PMID: 33471676 PMCID: PMC7837189 DOI: 10.4158/ep-2020-0237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/27/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Telehealth is a timely solution for delivering health care during the coronavirus disease 2019 (COVID-19) pandemic. The practice of endocrinology is suited to provide virtual care to patients with a variety of endocrine disorders. In this survey, we aimed to gauge the adoption of telehealth practices during the COVID-19 pandemic among endocrinologists in the United States (U.S.). METHODS This was a cross-sectional, online survey-based study. Members of the Facebook group "Endocrinologists" were invited to participate in the survey. Characteristics of respondents and their rates of adoption of telehealth were described and analyzed for statistically significant associations using the Pearson chi-square test. RESULTS A total of 181 physicians responded to the survey. The majority of respondents were females (75%), younger than or equal to 40 years of age (51%), employed (72%) either by a private group/hospital or by an academic setting, worked in an urban area (88.4%), and were adult endocrinologists (93%). With the COVID-19 outbreak, more than two-fifths (44.2%) of participants switched to completely virtual visits, and an additional 44.2% switched to a majority of virtual visits, with some in-person visits in the outpatient setting. Additionally, there was a significantly higher adoption rate of telehealth among endocrinologists younger than or equal to 40 years of age (P = .02) and among those who practiced in northeastern, midwestern, and the western geographic regions of the U.S. (P = .04). CONCLUSION The majority of the responding endocrinologists from the U.S. appeared to have swiftly adapted by using telehealth within a few weeks of COVID-19 being declared a national emergency. ABBREVIATIONS CMS = Centers for Medicare and Medicaid Services; COVID-19 = coronavirus disease 2019; PPE = personal protective equipment; U.S. = United States.
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Affiliation(s)
- Sujay Madduri
- From the Endocrinology, MidMichigan Health-University of Michigan Health System, Midland, Michigan..
| | - Raju Chowdhary
- Physical Therapy, MidMichigan Medical Center-Midland, Midland, Michigan
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Omara S, Wen D, Ng B, Anand R, Matin RN, Taghipour K, Esdaile B. Identification of Incidental Skin Cancers Among Adults Referred to Dermatologists for Suspicious Skin Lesions. JAMA Netw Open 2020; 3:e2030107. [PMID: 33326027 PMCID: PMC7745102 DOI: 10.1001/jamanetworkopen.2020.30107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The incidence of skin cancer is increasing and evaluation of the utility of total body skin examination (TBSE) in detecting incidental skin cancers is warranted. OBJECTIVES To evaluate the proportion and rate of incidental skin cancer detection in urgent skin cancer clinics and investigate the rate of incidental skin cancer detection in 2 groups based on the degree of clinical suspicion of the index lesion for malignancy. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective cohort study with a case note review of consecutive secondary care consultations was conducted using data from 2 urgent suspected skin cancer screening clinics in UK National Health Service trusts. The study was performed from January 1, 2015, to March 31, 2016, and data analysis was performed from October 14, 2018, to February 1, 2019. Patients included those presenting with a skin lesion suspicious of malignancy who were referred to the urgent suspected skin cancer clinic (N = 5944) over 15 months. Patients who accepted and received a TBSE were subsequently included in the analysis. MAIN OUTCOMES AND MEASURES The proportion and rate of incidental skin cancer detection through TBSE and whether a clinically suspicious (malignant) index lesion was associated with a higher chance of having a malignant incidental lesion. RESULTS Of the 5944 patients referred to the clinic, 4726 individuals (79.5%) were evaluated. In the cohort included in the analyses, the median age was 57 years (interquartile range, 39-73 years); 2567 patients (54.3%) were women. A total of 1117 skin cancers were identified; of these, 242 lesions (21.7%) were detected incidentally through TBSE, including 197 of 570 (34.6%) basal cell carcinomas, 16 of 250 (6.4%) squamous cell carcinomas, and 25 of 215 (11.6%) melanomas. The detection rate of incidental malignant lesions was 5.1 lesions per 100 patients examined (5.1%; 95% CI, 4.5%-5.8%). There was a higher detection rate of histologically confirmed incidental malignant lesions in individuals with clinically suspicious index lesions requiring biopsy (10.9%; 95% CI, 9.5%-12.5%) compared with those presenting with clinically benign index lesions (2.0%; 95% CI, 1.6%-2.5%) (P < .001). CONCLUSIONS AND RELEVANCE The findings of this study support the use of TBSE for urgent skin cancer referrals, highlighting the potential harms of solitary lesion assessment in a subgroup. Individuals presenting with a clinically suspicious index lesion requiring biopsy are most likely to benefit from TBSE and should be counseled regarding the benefit.
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Affiliation(s)
- Sharif Omara
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef, Leiden, the Netherlands
| | - David Wen
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Benjamin Ng
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Rakesh Anand
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
| | - Rubeta N. Matin
- Department of Dermatology, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Headington, Oxford, United Kingdom
| | - Kathy Taghipour
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
| | - Ben Esdaile
- Department of Dermatology, Whittington Health National Health Service Foundation Trust, London, United Kingdom
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Dovigi E, Kwok EYL, English JC. A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation. CURRENT DERMATOLOGY REPORTS 2020; 9:353-361. [PMID: 33200042 PMCID: PMC7658914 DOI: 10.1007/s13671-020-00323-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/07/2023]
Abstract
Purpose of Review Telemedicine use in dermatology, termed “teledermatology”, offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research. Recent Findings Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated. Summary This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided. Supplementary Information The online version contains supplementary material available at 10.1007/s13671-020-00323-0.
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Affiliation(s)
- Edwin Dovigi
- Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612 USA
| | | | - Joseph C. English
- Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA USA
- Center for Teledermatology, UPMC North Hills Dermatology, 9000, Brooktree Rd Suite 200, Wexford, PA 15044 USA
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Singhal RR, Talati KN, Gandhi BP, Shinde MK, Nair PA, Phatak AG. Prevalence and Pattern of Skin Diseases in Tribal Villages of Gujarat: A Teledermatology Approach. Indian J Community Med 2020; 45:199-203. [PMID: 32905082 PMCID: PMC7467180 DOI: 10.4103/ijcm.ijcm_76_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/26/2019] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology. Materials and Methods A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June-August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.
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Affiliation(s)
- Rochit Rajesh Singhal
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Kandarp Narendra Talati
- Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, Gujarat, India
| | | | - Mayur Kiran Shinde
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Pragya A Nair
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Ajay Gajanan Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
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21
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Andrees V, Klein T, Augustin M, Otten M. Live interactive teledermatology compared to in‐person care – a systematic review. J Eur Acad Dermatol Venereol 2020; 34:733-745. [DOI: 10.1111/jdv.16070] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- V. Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - T.M. Klein
- 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
| | - M. Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP) University Medical Center Hamburg‐Eppendorf (UKE) Hamburg Germany
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Abbott LM, Miller R, Janda M, Bennett H, Taylor ML, Arnold C, Shumack S, Soyer HP, Caffery LJ. A review of literature supporting the development of practice guidelines for teledermatology in Australia. Australas J Dermatol 2020; 61:e174-e183. [PMID: 32232852 DOI: 10.1111/ajd.13249] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/11/2019] [Accepted: 01/12/2020] [Indexed: 01/18/2023]
Abstract
Despite the potential of teledermatology to increase access to dermatology services and improve patient care, it is not widely practised in Australia. In an effort to increase uptake of teledermatology, Australian-specific practice guidelines for teledermatology are being developed by the Australasian College of Dermatologist. This paper reports finding from literature reviews that were undertaken to inform the development of these guidelines. Results cover the following sections: Modalities of teledermatology; Patient selection and consent; Imaging; Quality and safety; Privacy and security; Communication; and Documentation and retention. The document educates providers about the benefits and limitations of telehealth while articulating how to enhance patient care and reduce risk when practicing teledermatology.
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Affiliation(s)
- Lisa M Abbott
- Sydney Law School, University of Sydney, Sydney, New South Wales, Australia.,The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Robert Miller
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Haley Bennett
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Arnold
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia.,Hodgson Associates, Melbourne, Victoria, Australia
| | - Stephen Shumack
- The Australasian College of Dermatologists, Sydney, New South Wales, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
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Validation of a Short Questionnaire to Assess Healthcare Professionals' Perceptions of Asynchronous Telemedicine Services: The Catalan Version of the Health Optimum Telemedicine Acceptance Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072202. [PMID: 32218310 PMCID: PMC7178015 DOI: 10.3390/ijerph17072202] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
Telemedicine is both effective and able to provide efficient care at a lower cost. It also enjoys a high degree of acceptance among users. The Technology Acceptance Model proposed is based on the two main concepts of ease of use and perceived usefulness and is comprised of three dimensions: the individual context, the technological context and the implementation or organizational context. At present, no short, validated questionnaire exists in Catalonia to evaluate the acceptance of telemedicine services amongst healthcare professionals using a technology acceptance model. This article aims to statistically validate the Catalan version of the EU project Health Optimum telemedicine acceptance questionnaire. The study included the following phases: adaptation and translation of the questionnaire into Catalan and psychometric validation with construct (exploratory factor analysis), consistency (Cronbach’s alpha) and stability (test–retest) analysis. After deleting incomplete responses, calculations were made using 33 participants. The internal consistency measured with the Cronbach’s alpha coefficient was good with an alpha coefficient of 0.84 (95%, CI: 0.79–0.84). The intraclass correlation coefficient was 0.93 (95% CI: 0.852–0.964). The Kaiser–Meyer–Olkin test of sampling showed to be adequate (KMO = 0.818) and the Bartlett test of sphericity was significant (Chi-square 424.188; gl = 28; p < 0.001). The questionnaire had two dimensions which accounted for 61.2% of the total variance: quality and technical difficulties relating to telemedicine. The findings of this study suggest that the validated questionnaire has robust statistical features that make it a good predictive model of healthcare professional’s satisfaction with telemedicine programs.
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Greenwald E, Tan A, Stein JA, Liebman TN, Bowling A, Polsky D. Real-world outcomes of melanoma surveillance using the MoleMap NZ telemedicine platform. J Am Acad Dermatol 2020; 85:596-603. [PMID: 32114083 DOI: 10.1016/j.jaad.2020.02.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND MoleMap NZ is a novel New Zealand-based store-and-forward telemedicine service to detect melanoma. It uses expert review of total body photography and close-up and dermoscopic images of skin lesions that are suspicious for malignancy. OBJECTIVE The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program. METHODS We conducted a review of 2108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists between January 2015 and December 2016. RESULTS Pathologic diagnoses were available for 1571 lesions. Of these, 1303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign:malignant ratio of 5.0:1. The number needed to biopsy to obtain 1 melanoma was 6. Among melanomas with available tumor thickness data (n = 137), 92% were <0.8 mm (range in situ to 3.1 mm), with in situ melanomas comprising 74%. LIMITATIONS Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data were available for 53% of melanomas diagnosed. CONCLUSIONS This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.
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Affiliation(s)
- Elizabeth Greenwald
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Andrea Tan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Tracey N Liebman
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | | | - David Polsky
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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25
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Gupta P, Tolliver S, Zhang M, Schumacher E, Kaffenberger BH. Impact of dermatology and teledermatology consultations for patients admitted with cellulitis: A pilot study. J Am Acad Dermatol 2020; 82:513-515. [DOI: 10.1016/j.jaad.2019.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/29/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
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26
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Pasquali P, Sonthalia S, Moreno-Ramirez D, Sharma P, Agrawal M, Gupta S, Kumar D, Arora D. Teledermatology and its Current Perspective. Indian Dermatol Online J 2020; 11:12-20. [PMID: 32055502 PMCID: PMC7001387 DOI: 10.4103/idoj.idoj_241_19] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Teledermatology is one of the most important and commonly employed subsets of telemedicine, a special alternative to face-to-face (FTF) doctor--patient consultation that refers to the use of electronic telecommunication tools to facilitate the provision of healthcare between the "seeker" and "provider." It is used for consultation, education, second opinion, and monitoring medical conditions. This article will review basic concepts, the integration of noninvasive imaging technique images, artificial intelligence, and the current ethical and legal issues.
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Affiliation(s)
- Paola Pasquali
- Dermatology Department, Pius Hospital de Valls, Tarragona, Spain
| | | | | | - Pooram Sharma
- Skin Institute and School of Dermatology, New Delhi, India
| | - Mahima Agrawal
- Department of Dermatology and STD, LHMC & Associated Hospitals, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Dinesh Kumar
- Dr. Dinesh´s Skin and Hair Clinic, Chennai, Tamil Nadu, India
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27
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Abstract
The modern Western medical encounter follows a strict framework that weaves subjective and objective components into a unifying diagnosis. As health care changes to incorporate new technology, such as virtual health care, the components that lead to diagnosis must likewise evolve. The virtual physical exam has limitations compared with the traditional exam. Despite this limitation, every year more patients are seen virtually with high satisfaction. Data have shown that supplementary real-time patient-provider video telemedicine increases access and extends established patient-physician relationships which will likely fuel increased telemedicine adoption even further. However, to date, there are limited data regarding the validity of the virtual examination compared with the traditional physical exam. In this paper, we review the use of developing technology related to the virtual physical exam.
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Affiliation(s)
- Ali M Ansary
- Department of Medicine, University of Washington, USA
| | | | - John D Scott
- Department of Medicine, University of Washington, USA
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28
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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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29
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Caffery LJ, Clunie D, Curiel-Lewandrowski C, Malvehy J, Soyer HP, Halpern AC. Transforming Dermatologic Imaging for the Digital Era: Metadata and Standards. J Digit Imaging 2019; 31:568-577. [PMID: 29344752 DOI: 10.1007/s10278-017-0045-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an impediment to clinical uptake. Standardization can occur in image acquisition, terminology, interoperability, and metadata. This paper presents the International Skin Imaging Collaboration position on standardization of metadata for dermatologic imaging. Metadata is essential to ensure that dermatologic images are properly managed and interpreted. There are two standards-based approaches to recording and storing metadata in dermatologic imaging. The first uses standard consumer image file formats, and the second is the file format and metadata model developed for the Digital Imaging and Communication in Medicine (DICOM) standard. DICOM would appear to provide an advantage over using consumer image file formats for metadata as it includes all the patient, study, and technical metadata necessary to use images clinically. Whereas, consumer image file formats only include technical metadata and need to be used in conjunction with another actor-for example, an electronic medical record-to supply the patient and study metadata. The use of DICOM may have some ancillary benefits in dermatologic imaging including leveraging DICOM network and workflow services, interoperability of images and metadata, leveraging existing enterprise imaging infrastructure, greater patient safety, and better compliance to legislative requirements for image retention.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia.
| | | | - Clara Curiel-Lewandrowski
- University of Arizona Cancer Center/Skin Cancer Institute and Division of Dermatology, University of Arizona, Tucson, AZ, USA
| | - Josep Malvehy
- Dermatology Department, Hospital Clinic, IDIBAPS, CIBER de enfermedades raras, University of Barcelona, Barcelona, Spain
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
- Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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30
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Snoswell CL, Caffery LJ, Whitty JA, Soyer HP, Gordon LG. Cost-effectiveness of Skin Cancer Referral and Consultation Using Teledermoscopy in Australia. JAMA Dermatol 2019; 154:694-700. [PMID: 29801161 DOI: 10.1001/jamadermatol.2018.0855] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance International literature has shown that teledermoscopy referral may be a viable method for skin cancer referral; however, no economic investigations have occurred in Australia. Objective To assess the cost-effectiveness of teledermoscopy as a referral mechanism for skin cancer diagnosis and management in Australia. Design, Setting, and Participants Cost-effectiveness analysis using a decision-analytic model of Australian primary care, informed by publicly available data. Interventions We compared the costs of teledermoscopy referral (electronic referral containing digital dermoscopic images) vs usual care (a written referral letter) for specialist dermatologist review of a suspected skin cancer. Main Outcomes and Measures Cost and time in days to clinical resolution, where clinical resolution was defined as diagnosis by a dermatologist or excision by a general practitioner. Probabilistic sensitivity analysis was performed to examine the uncertainty of the main results. Results Findings from the decision-analytic model showed that the mean time to clinical resolution was 9 days (range, 1-50 days) with teledermoscopy referral compared with 35 days (range, 0-138 days) with usual care alone (difference, 26 days; 95% credible interval [CrI], 13-38 days). The estimated mean cost difference between teledermoscopy referral (A$318.39) vs usual care (A$263.75) was A$54.64 (95% CrI, A$22.69-A$97.35) per person. The incremental cost per day saved to clinical resolution was A$2.10 (95% CrI, A$0.87-A$5.29). Conclusions and Relevance Using teledermoscopy for skin cancer referral and triage in Australia would cost A$54.64 extra per case on average but would result in clinical resolution 26 days sooner than usual care. Implementation recommendations depend on the preferences of the Australian health system decision makers for either lower cost or expedited clinical resolution. Further research around the clinical significance of expedited clinical resolution and its importance for patients could inform implementation recommendations for the Australian setting.
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Affiliation(s)
| | - Liam J Caffery
- Centre for Online Health, University of Queensland, Brisbane, Australia
| | - Jennifer A Whitty
- School of Pharmacy, University of Queensland, Brisbane, Australia.,Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, England
| | - H Peter Soyer
- Dermatology Research Centre, University of Queensland, University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Australia.,School of Public Health, University of Queensland, Brisbane, Australia
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31
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de Carvalho TM, Noels E, Wakkee M, Udrea A, Nijsten T. Development of Smartphone Apps for Skin Cancer Risk Assessment: Progress and Promise. JMIR DERMATOLOGY 2019. [DOI: 10.2196/13376] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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32
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Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The Current State Of Telehealth Evidence: A Rapid Review. Health Aff (Millwood) 2019; 37:1975-1982. [PMID: 30633674 DOI: 10.1377/hlthaff.2018.05132] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Policy makers and practitioners show a continued interest in telehealth's potential to increase efficiency and reach patients facing access barriers. However, telehealth encompasses many applications for varied conditions and populations. It is therefore difficult to draw broad conclusions about telehealth's efficacy. This rapid review examines recent evidence both about telehealth's efficacy by clinical area and about telehealth's impact on utilization. We searched for systematic reviews and meta-analyses of the use of telehealth services by patients of any age for any condition published in English in the period January 2004-May 2018. Twenty systematic reviews and associated meta-analyses are included in this review, covering clinical areas such as mental health and rehabilitation. Broadly, telehealth interventions appear generally equivalent to in-person care. However, telehealth's impact on the use of other services is unclear. Many factors should be carefully considered when weighing the evidence of telehealth's efficacy, including modality, evidence quality, population demographics, and point-in-time measurement of outcomes.
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Affiliation(s)
- Erin Shigekawa
- Erin Shigekawa ( ) is a consultant, John Snow, Inc. (JSI), in San Francisco, California. She was a principal analyst in the California Health Benefits Review Program, University of California Berkeley, when this work was completed
| | - Margaret Fix
- Margaret Fix is a research associate at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
| | - Garen Corbett
- Garen Corbett is director of the California Health Benefits Review Program, University of California Berkeley
| | - Dylan H Roby
- Dylan H. Roby is an associate professor in and associate chair of the Department of Health Services Administration at the University of Maryland School of Public Health, in College Park; an adjunct associate professor in the Fielding School of Public Health, University of California Los Angeles (UCLA); and a faculty associate in the UCLA Center for Health Policy Research
| | - Janet Coffman
- Janet Coffman is a full adjunct professor at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco
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33
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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: 23] [Impact Index Per Article: 4.6] [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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34
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Exploration of benefits realisation management for teledermatology scale-up framework development and sustainable scaling. INFORMATICS IN MEDICINE UNLOCKED 2019. [DOI: 10.1016/j.imu.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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35
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Dos Santos ADF, Mata-Machado ATGD, Melo MDCBD, Fonseca Sobrinho D, Araújo LL, Silva ÉA, Lima AMDLDD, Abreu DMXD, Rocha HAD. Implementation of Telehealth Resources in Primary Care in Brazil and Its Association with Quality of Care. Telemed J E Health 2018; 25:996-1004. [PMID: 30592699 DOI: 10.1089/tmj.2018.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Although several reviews on the relation between telemedicine and health care outcomes have pointed out some evidence, they have also underscored the need for further investigation. Introduction: Brazil has a national telehealth program implemented in 2007, involving teleconsulting and distance education actions in primary care. Objective: This study aims to describe the implementation of telehealth in primary care in Brazil and to identify if there is an association between telehealth and quality of care. Methods: A cross-sectional study analyzing data from interviews with 29,778 primary care team professionals in Brazil in 2014, which represents 92.5% of existing health care teams, on aspects of information technology, telehealth, and care was carried out. A multiple binary regression analysis was performed to study the associations between the extent of health care actions and using telehealth. Results: Of the 24,055 primary care units in Brazil where teams worked, only 50.1% (n: 12,055) had internet access, and 32.71% of teams claimed to be involved in telehealth actions in 2014. Between 2012 and 2014 there was an expansion in the use of telehealth resources in all regions of Brazil. The highest magnitude was observed for the association between employment of telehealth and improvement in child care (odds ratio [OR] = 2.09), followed by diabetes mellitus care (OR = 1.91), hypertension (OR = 1.89), and finally, women's health (OR = 1.86).
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Affiliation(s)
| | | | | | | | - Lucas Lobato Araújo
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Érica Araújo Silva
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Hugo André da Rocha
- Nescon, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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36
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Chuchu N, Dinnes J, Takwoingi Y, Matin RN, Bayliss SE, Davenport C, Moreau JF, Bassett O, Godfrey K, O'Sullivan C, Walter FM, Motley R, Deeks JJ, Williams HC. Teledermatology for diagnosing skin cancer in adults. Cochrane Database Syst Rev 2018; 12:CD013193. [PMID: 30521686 PMCID: PMC6517019 DOI: 10.1002/14651858.cd013193] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and squamous cell carcinoma (SCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Teledermatology provides a way for generalist clinicians to access the opinion of a specialist dermatologist for skin lesions that they consider to be suspicious without referring the patients through the normal referral pathway. Teledermatology consultations can be 'store-and-forward' with electronic digital images of a lesion sent to a dermatologist for review at a later time, or can be live and interactive consultations using videoconferencing to connect the patient, referrer and dermatologist in real time. OBJECTIVES To determine the diagnostic accuracy of teledermatology for the detection of any skin cancer (melanoma, BCC or cutaneous squamous cell carcinoma (cSCC)) in adults, and to compare its accuracy with that of in-person diagnosis. SEARCH METHODS We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, US National Institutes of Health Ongoing Trials Register, NIHR Clinical Research Network Portfolio Database and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies evaluating skin cancer diagnosis for teledermatology alone, or in comparison with face-to-face diagnosis by a specialist clinician, compared with a reference standard of histological confirmation or clinical follow-up and expert opinion. We also included studies evaluating the referral accuracy of teledermatology compared with a reference standard of face-to-face diagnosis by a specialist clinician. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where there were information related to the target condition of any skin cancer missing. Data permitting, we estimated summary sensitivities and specificities using the bivariate hierarchical model. Due to the scarcity of data, we undertook no covariate investigations for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for diagnostic threshold and target condition under consideration. MAIN RESULTS The review included 22 studies reporting diagnostic accuracy data for 4057 lesions and 879 malignant cases (16 studies) and referral accuracy data for reported data for 1449 lesions and 270 'positive' cases as determined by the reference standard face-to-face decision (six studies). Methodological quality was variable with poor reporting hindering assessment. The overall risk of bias was high or unclear for participant selection, reference standard, and participant flow and timing in at least half of all studies; the majority were at low risk of bias for the index test. The applicability of study findings were of high or unclear concern for most studies in all domains assessed due to the recruitment of participants from secondary care settings or specialist clinics rather than from primary or community-based settings in which teledermatology is more likely to be used and due to the acquisition of lesion images by dermatologists or in specialist imaging units rather than by primary care clinicians.Seven studies provided data for the primary target condition of any skin cancer (1588 lesions and 638 malignancies). For the correct diagnosis of lesions as malignant using photographic images, summary sensitivity was 94.9% (95% confidence interval (CI) 90.1% to 97.4%) and summary specificity was 84.3% (95% CI 48.5% to 96.8%) (from four studies). Individual study estimates using dermoscopic images or a combination of photographic and dermoscopic images generally suggested similarly high sensitivities with highly variable specificities. Limited comparative data suggested similar diagnostic accuracy between teledermatology assessment and in-person diagnosis by a dermatologist; however, data were too scarce to draw firm conclusions. For the detection of invasive melanoma or atypical intraepidermal melanocytic variants both sensitivities and specificities were more variable. Sensitivities ranged from 59% (95% CI 42% to 74%) to 100% (95% CI 48% to 100%) and specificities from 30% (95% CI 22% to 40%) to 100% (95% CI 93% to 100%), with reported diagnostic thresholds including the correct diagnosis of melanoma, classification of lesions as 'atypical' or 'typical, and the decision to refer or to excise a lesion.Referral accuracy data comparing teledermatology against a face-to-face reference standard suggested good agreement for lesions considered to require some positive action by face-to-face assessment (sensitivities of over 90%). For lesions considered of less concern when assessed face-to-face (e.g. for lesions not recommended for excision or referral), agreement was more variable with teledermatology specificities ranging from 57% (95% CI 39% to 73%) to 100% (95% CI 86% to 100%), suggesting that remote assessment is more likely recommend excision, referral or follow-up compared to in-person decisions. AUTHORS' CONCLUSIONS Studies were generally small and heterogeneous and methodological quality was difficult to judge due to poor reporting. Bearing in mind concerns regarding the applicability of study participants and of lesion image acquisition in specialist settings, our results suggest that teledermatology can correctly identify the majority of malignant lesions. Using a more widely defined threshold to identify 'possibly' malignant cases or lesions that should be considered for excision is likely to appropriately triage those lesions requiring face-to-face assessment by a specialist. Despite the increasing use of teledermatology on an international level, the evidence base to support its ability to accurately diagnose lesions and to triage lesions from primary to secondary care is lacking and further prospective and pragmatic evaluation is needed.
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Affiliation(s)
- Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Jacqueline F Moreau
- University of Pittsburgh Medical CenterInternal MedicineDepartment of Medicine, Office of EducationUPMC Montefiore Hospital, N715PittsburghUSAPA, 15213
| | - Oliver Bassett
- Addenbrooke's HospitalPlastic SurgeryHills RoadCambridgeUKCB2 0QQ
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | | | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Richard Motley
- University Hospital of WalesWelsh Institute of DermatologyHeath ParkCardiffUKCF14 4XW
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Chuchu N, Takwoingi Y, Dinnes J, Matin RN, Bassett O, Moreau JF, Bayliss SE, Davenport C, Godfrey K, O'Connell S, Jain A, Walter FM, Deeks JJ, Williams HC. Smartphone applications for triaging adults with skin lesions that are suspicious for melanoma. Cochrane Database Syst Rev 2018; 12:CD013192. [PMID: 30521685 PMCID: PMC6517294 DOI: 10.1002/14651858.cd013192] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Melanoma accounts for a small proportion of all skin cancer cases but is responsible for most skin cancer-related deaths. Early detection and treatment can improve survival. Smartphone applications are readily accessible and potentially offer an instant risk assessment of the likelihood of malignancy so that the right people seek further medical attention from a clinician for more detailed assessment of the lesion. There is, however, a risk that melanomas will be missed and treatment delayed if the application reassures the user that their lesion is low risk. OBJECTIVES To assess the diagnostic accuracy of smartphone applications to rule out cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in adults with concerns about suspicious skin lesions. SEARCH METHODS We undertook a comprehensive search of the following databases from inception to August 2016: Cochrane Central Register of Controlled Trials; MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles. SELECTION CRITERIA Studies of any design evaluating smartphone applications intended for use by individuals in a community setting who have lesions that might be suspicious for melanoma or atypical intraepidermal melanocytic variants versus a reference standard of histological confirmation or clinical follow-up and expert opinion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). Due to scarcity of data and poor quality of studies, we did not perform a meta-analysis for this review. For illustrative purposes, we plotted estimates of sensitivity and specificity on coupled forest plots for each application under consideration. MAIN RESULTS This review reports on two cohorts of lesions published in two studies. Both studies were at high risk of bias from selective participant recruitment and high rates of non-evaluable images. Concerns about applicability of findings were high due to inclusion only of lesions already selected for excision in a dermatology clinic setting, and image acquisition by clinicians rather than by smartphone app users.We report data for five mobile phone applications and 332 suspicious skin lesions with 86 melanomas across the two studies. Across the four artificial intelligence-based applications that classified lesion images (photographs) as melanomas (one application) or as high risk or 'problematic' lesions (three applications) using a pre-programmed algorithm, sensitivities ranged from 7% (95% CI 2% to 16%) to 73% (95% CI 52% to 88%) and specificities from 37% (95% CI 29% to 46%) to 94% (95% CI 87% to 97%). The single application using store-and-forward review of lesion images by a dermatologist had a sensitivity of 98% (95% CI 90% to 100%) and specificity of 30% (95% CI 22% to 40%).The number of test failures (lesion images analysed by the applications but classed as 'unevaluable' and excluded by the study authors) ranged from 3 to 31 (or 2% to 18% of lesions analysed). The store-and-forward application had one of the highest rates of test failure (15%). At least one melanoma was classed as unevaluable in three of the four application evaluations. AUTHORS' CONCLUSIONS Smartphone applications using artificial intelligence-based analysis have not yet demonstrated sufficient promise in terms of accuracy, and they are associated with a high likelihood of missing melanomas. Applications based on store-and-forward images could have a potential role in the timely presentation of people with potentially malignant lesions by facilitating active self-management health practices and early engagement of those with suspicious skin lesions; however, they may incur a significant increase in resource and workload. Given the paucity of evidence and low methodological quality of existing studies, it is not possible to draw any implications for practice. Nevertheless, this is a rapidly advancing field, and new and better applications with robust reporting of studies could change these conclusions substantially.
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Affiliation(s)
- Naomi Chuchu
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Yemisi Takwoingi
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Jacqueline Dinnes
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Rubeta N Matin
- Churchill HospitalDepartment of DermatologyOld RoadHeadingtonOxfordUKOX3 7LE
| | - Oliver Bassett
- Addenbrooke's HospitalPlastic SurgeryHills RoadCambridgeUKCB2 0QQ
| | - Jacqueline F Moreau
- University of Pittsburgh Medical CenterInternal MedicineDepartment of Medicine, Office of EducationUPMC Montefiore Hospital, N715PittsburghUSAPA, 15213
| | - Susan E Bayliss
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Clare Davenport
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
| | - Kathie Godfrey
- The University of Nottinghamc/o Cochrane Skin GroupNottinghamUK
| | - Susan O'Connell
- Cardiff and Vale University Health BoardCEDAR Healthcare Technology Research CentreCardiff Medicentre, University Hospital of Wales, Heath Park CampusCardiffWalesUKCF144UJ
| | - Abhilash Jain
- Imperial College Healthcare NHS trust, St Mary’s HospitalDepartment of Plastic and Reconstructive SurgeryLondonUKW2 1NY
| | - Fiona M Walter
- University of CambridgePublic Health & Primary CareStrangeways Research Laboratory, Worts CausewayCambridgeUKCB1 8RN
| | - Jonathan J Deeks
- University of BirminghamInstitute of Applied Health ResearchBirminghamUKB15 2TT
- University Hospitals Birmingham NHS Foundation Trust and University of BirminghamNIHR Birmingham Biomedical Research CentreBirminghamUK
| | - Hywel C Williams
- University of NottinghamCentre of Evidence Based DermatologyQueen's Medical CentreDerby RoadNottinghamUKNG7 2UH
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Walters LEM, Scott RE, Mars M. Teledermatology scale-up frameworks: a structured review and critique. BMC Health Serv Res 2018; 18:613. [PMID: 30086738 PMCID: PMC6081905 DOI: 10.1186/s12913-018-3418-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The South African public health sector embarked on a National Telemedicine System implementation program in 1999 and although unsuccessful, the Province of KwaZulu-Natal subsequently implemented teledermatology in 2003, with two currently active services (synchronous and asynchronous). Although sustained these have not been scaled-up to meet the needs of all hospitals in the Province. A recent teledermatology scale-up design requirements elicitation process within KwaZulu-Natal confirmed the need for a framework, and identified requirements through key stakeholders, programme observations, the literature, and experts. This study aimed to identify and characterise existing teledermatology or related eHealth scale-up frameworks, determine whether any met the previously elicited scale-up framework requirements, and were suitable for use in the KwaZulu-Natal public health sector. METHODS A structured literature search was performed of electronic databases (Scopus, Science Direct, IEEE, PubMed, and Google Scholar) seeking proposed or developed teledermatology or related scale-up frameworks. Global public health publications were also hand-searched. The teledermatology or telemedicine, telehealth or eHealth related scale-up frameworks identified were critiqued against the previously elicited teledermatology scale-up framework requirements to determine their suitability for use. RESULTS No specific teledermatology scale-up framework was found. Seven related scale-up frameworks were identified, although none met all the previously identified teledermatology scale-up framework requirements. The identified frameworks were designed for specific scale-up phases and lacked a more holistic and comprehensive approach. CONCLUSIONS There is an evidenced-based need for the development of a health sector aligned, holistic framework that meets the identified teledermatology scale-up framework requirements. The findings of this paper will inform development of such a framework.
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Affiliation(s)
- Laticha Elizabeth Marolana Walters
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Council for Scientific and Industrial Research (CSIR), Meraka Institute, Pretoria, South Africa
| | - Richard Ernest Scott
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- NT Consulting - Global e-Health Inc., Calgary, Canada
| | - Maurice Mars
- Department of TeleHealth, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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Walters LEM, Scott RE, Mars M. A Teledermatology Scale-Up Framework and Roadmap for Sustainable Scaling: Evidence-Based Development. J Med Internet Res 2018; 20:e224. [PMID: 29925492 PMCID: PMC6031901 DOI: 10.2196/jmir.9940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background The objectives of South Africa’s electronic health (eHealth) strategy recognize the value proposition that telemedicine practices hold for rural and urban referrals, but a lack of accepted and formalized scale-up has impeded realization of benefits. While both synchronous and asynchronous teledermatology exist, these remain localized and not scaled-up. Skin pathology is often the first sign of an HIV/AIDS infection, which remains a major cause of morbidity and mortality in South Africa. It is essential to replace the current inefficient dermatology referral process with a swift, organized, and efficacious one. Objective The objective of this study is to present an evidenced-based teledermatology scale-up framework (TDSF) and implementation roadmap (TDSF-IR). Methods A qualitative method with a design science research process model was used which consisted of 5 phases: (1) Awareness, which confirmed the need for an evidence-based TDSF and supporting TDSF-IR; (2) Suggestion, where a proposal was delivered on how to develop a TDSF and TDSF-IR; (3) Development, where we identified recommended design requirements and used these to identify and critique existing teledermatology or related scale-up frameworks; (4) Evaluation and validation, where we assessed outputs of the development phase against the design requirements and validated by confirming the veracity of the TDSF and TDSF-IR (validation involved 4 key senior teledermatology stakeholders using a questionnaire with a 5-point Likert scale); and (5) Conclusion, where validation results were used to finalize and communicate the TDSF and TDSF-IR to users. Results The study identified 5 TDSF components: eHealth building blocks, eHealth strategic objectives and budget, scale-up continuum periods, scale-up drivers, and scale-up phases. In addition, 36 subcomponents were identified. Each was further characterized and described to enable design of the final evidence-based TDSF. An implementation roadmap (TDSF-IR) was also prepared as a guide for an implementer with step-by-step instructions for application of the TDSF. For the validation study of the TDSF and supporting TDSF-IR, 4 purposively selected key senior teledermatology management stakeholders were asked if they found it useful as a guide to assist the South African public health system with teledermatology scale-up. The mean (SD) of Likert-scale rating was 4.0 (0.53) where 4=Agree and 33 of 36 responses were either agree or strongly agree. Conclusions This study developed a TDSF and supporting roadmap (TDSF-IR) that are evidence-based. The proposed approach and described tools could be adapted to assist with ensuring scale-up and sustainability for other eHealth practices in other locations.
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Affiliation(s)
- Laticha Elizabeth Marolana Walters
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,Meraka Institute, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Richard Ernest Scott
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.,NT Consulting - Global e-Health Inc, Calgary, AB, Canada
| | - Maurice Mars
- Department of TeleHealth, University of KwaZulu-Natal, Durban, South Africa
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Weinstein RS, Krupinski EA, Doarn CR. Clinical Examination Component of Telemedicine, Telehealth, mHealth, and Connected Health Medical Practices. Med Clin North Am 2018; 102:533-544. [PMID: 29650074 DOI: 10.1016/j.mcna.2018.01.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Telemedicine and telehealth are the practices of medicine at a distance. Performing the equivalent of a complete clinical examination by telemedicine would be unusual. However, components of a more traditional clinical examination are part of the telemedicine workup for specific conditions. Telemedicine clinical examinations are facilitated, and enhanced, through the integration of a class of medical devices referred to as telemedicine peripherals (eg, electronic stethoscopes, tele-ophthalmoscopes, video-otoscopes, and so forth). Direct-to-consumer telehealth is a rapidly expanding segment of the health care service industry.
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Affiliation(s)
- Ronald S Weinstein
- Arizona Telemedicine Program, University of Arizona College of Medicine, 1501 North Campbell Avenue, Tucson, AZ 85724, USA.
| | - Elizabeth A Krupinski
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast D107, Atlanta, GA 30322, USA
| | - Charles R Doarn
- Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267-0582, USA
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Powell RE, Stone D, Hollander JE. Patient and Health System Experience With Implementation of an Enterprise-Wide Telehealth Scheduled Video Visit Program: Mixed-Methods Study. JMIR Med Inform 2018; 6:e10. [PMID: 29439947 PMCID: PMC5829457 DOI: 10.2196/medinform.8479] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Real-time video visits are increasingly used to provide care in a number of settings because they increase access and convenience of care, yet there are few reports of health system experiences. OBJECTIVE The objective of this study is to report health system and patient experiences with implementation of a telehealth scheduled video visit program across a health system. METHODS This is a mixed methods study including (1) a retrospective descriptive report of implementation of a telehealth scheduled visit program at one large urban academic-affiliated health system and (2) a survey of patients who participated in scheduled telehealth visits. Health system and patient-reported survey measures were aligned with the National Quality Forum telehealth measure reporting domains of access, experience, and effectiveness of care. RESULTS This study describes implementation of a scheduled synchronous video visit program over an 18-month period. A total of 3018 scheduled video visits were completed across multiple clinical departments. Patient experiences were captured in surveys of 764 patients who participated in telehealth visits. Among survey respondents, 91.6% (728/795) reported satisfaction with the scheduled visits and 82.7% (628/759) reported perceived quality similar to an in-person visit. A total of 86.0% (652/758) responded that use of the scheduled video visit made it easier to get care. Nearly half (46.7%, 346/740) of patients estimated saving 1 to 3 hours and 40.8% (302/740) reported saving more than 3 hours of time. The net promoter score, a measure of patient satisfaction, was very high at 52. CONCLUSIONS A large urban multihospital health system implemented an enterprise-wide scheduled telehealth video visit program across a range of clinical specialties with a positive patient experience. Patients found use of scheduled video visits made it easier to get care and the majority perceived time saved, suggesting that use of telehealth for scheduled visits can improve potential access to care across a range of clinical scenarios with favorable patient experiences.
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Affiliation(s)
- Rhea E Powell
- Thomas Jefferson University, Philadelphia, PA, United States
| | - Danica Stone
- Thomas Jefferson University, Philadelphia, PA, United States
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Bashshur RL, Howell JD, Krupinski EA, Harms KM, Bashshur N, Doarn CR. The Empirical Foundations of Telemedicine Interventions in Primary Care. Telemed J E Health 2017; 22:342-75. [PMID: 27128779 DOI: 10.1089/tmj.2016.0045] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merits of telemedicine interventions in primary care. Although there is no uniform and consistent definition of primary care, most agree that it occupies a central role in the healthcare system as first contact for patients seeking care, as well as gatekeeper and coordinator of care. It enables and supports patient-centered care, the medical home, managed care, accountable care, and population health. Increasing concerns about sustainability and the anticipated shortages of primary care physicians have sparked interest in exploring the potential of telemedicine in addressing many of the challenges facing primary care in the United States and the world. MATERIALS AND METHODS The findings are based on a systematic review of scientific studies published from 2005 through 2015. The initial search yielded 2,308 articles, with 86 meeting the inclusion criteria. Evidence is organized and evaluated according to feasibility/acceptance, intermediate outcomes, health outcomes, and cost. RESULTS The majority of studies support the feasibility/acceptance of telemedicine for use in primary care, although it varies significantly by demographic variables, such as gender, age, and socioeconomic status, and telemedicine has often been found more acceptable by patients than healthcare providers. Outcomes data are limited but overall suggest that telemedicine interventions are generally at least as effective as traditional care. Cost analyses vary, but telemedicine in primary care is increasingly demonstrated to be cost-effective. CONCLUSIONS Telemedicine has significant potential to address many of the challenges facing primary care in today's healthcare environment. Challenges still remain in validating its impact on clinical outcomes with scientific rigor, as well as in standardizing methods to assess cost, but patient and provider acceptance is increasingly making telemedicine a viable and integral component of primary care around the world.
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Affiliation(s)
- Rashid L Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Joel D Howell
- 2 Department of Internal Medicine, University of Michigan , Ann Arbor, Michigan.,3 Department of History and Health Management and Policy, University of Michigan , Ann Arbor, Michigan
| | | | - Kathryn M Harms
- 5 Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 University of Michigan Health System, University of Michigan , Ann Arbor, Michigan
| | - Charles R Doarn
- 6 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio
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Wang M, Gendreau JL, Gemelas J, Capulong D, Lau C, Mata-Diaz S, Bratten DM, Dougall B, Markham C, Raugi GJ. Diagnosis and Management of Malignant Melanoma in Store-and-Forward Teledermatology. Telemed J E Health 2017; 23:877-880. [DOI: 10.1089/tmj.2017.0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Melinda Wang
- Department of Biochemistry, University of Washington, Seattle, Washington
| | - James L. Gendreau
- School of Public Health, University of Washington, Seattle, Washington
| | - Jordan Gemelas
- School of Public Health, University of Washington, Seattle, Washington
| | - Dana Capulong
- Department of Microbiology, University of Washington, Seattle, Washington
| | - Clayton Lau
- School of Public Health, University of Washington, Seattle, Washington
| | - Sandra Mata-Diaz
- School of Public Health, University of Washington, Seattle, Washington
| | - Dustin M. Bratten
- Department of Biochemistry, University of Washington, Seattle, Washington
| | - Brittany Dougall
- Department of Biology, University of Washington, Seattle, Washington
| | - Craig Markham
- VHA Puget Sound Health Care System, Seattle, Washington
| | - Gregory J. Raugi
- VHA Puget Sound Health Care System, Seattle, Washington
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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Seol JE, Park SH, Kim H. Analysis of live interactive teledermatologic consultations for prisoners in Korea for 3 years. J Telemed Telecare 2017; 24:623-628. [PMID: 28954580 DOI: 10.1177/1357633x17732095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Teledermatology has contributed to the enhanced accessibility of underserved populations. This study investigated the prevalence and clinical outcomes of dermatologic diseases in prisoners in Korea through live interactive teledermatology (LITD) Method The medical records of patients in a Busan prison, who interacted with a dermatologist using LITD from July 2013 to August 2016, were reviewed retrospectively. Results The mean age of the 406 patients enrolled in the study was 39.0 years and 91.4% were male. Infectious disease (42.8%) was the most common type of disease, followed by eczematous disease (29.4%) and diseases of the skin appendages (14.5%). Among the 187 (38.2%) patients who had a follow-up consultation, 162 (86.7%) showed clinical improvement, whereas 21 showed either no change or a worse clinical outcome. Twenty patients were diagnosed with different types of dermatologic disease at follow-up consultations. Discussion LITD can contribute to a favourable clinical outcome and may thus be an effective alternative to face-to-face consultation in prisoners and other underserved populations.
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Affiliation(s)
- Jung Eun Seol
- Department of Dermatology, Busan Paik Hospital, Busan, Korea
| | - So Hee Park
- Department of Dermatology, Busan Paik Hospital, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Busan Paik Hospital, Busan, Korea
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Gendreau JL, Gemelas J, Wang M, Capulong D, Lau C, Bratten DM, Dougall B, Markham C, Raugi GJ. Unimaged Melanomas in Store-and-Forward Teledermatology. Telemed J E Health 2017; 23:517-520. [DOI: 10.1089/tmj.2016.0170] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James L. Gendreau
- School of Public Health, University of Washington, Seattle, Washington
| | - Jordan Gemelas
- School of Public Health, University of Washington, Seattle, Washington
| | - Melinda Wang
- Department of Biochemistry, University of Washington, Seattle, Washington
| | - Dana Capulong
- Department of Microbiology, University of Washington, Seattle, Washington
| | - Clayton Lau
- School of Public Health, University of Washington, Seattle, Washington
| | - Dustin M. Bratten
- Department of Biochemistry, University of Washington, Seattle, Washington
| | - Brittany Dougall
- Department of Biology, University of Washington, Seattle, Washington
| | - Craig Markham
- VHA Puget Sound Health Care System, Seattle, Washington
| | - Gregory J. Raugi
- VHA Puget Sound Health Care System, Seattle, Washington
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington
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Young HM, Nesbitt TS. Increasing the Capacity of Primary Care Through Enabling Technology. J Gen Intern Med 2017; 32:398-403. [PMID: 28243871 PMCID: PMC5377889 DOI: 10.1007/s11606-016-3952-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/13/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023]
Abstract
Primary care is the foundation of effective and high-quality health care. The role of primary care clinicians has expanded to encompass coordination of care across multiple providers and management of more patients with complex conditions. Enabling technology has the potential to expand the capacity for primary care clinicians to provide integrated, accessible care that channels expertise to the patient and brings specialty consultations into the primary care clinic. Furthermore, technology offers opportunities to engage patients in advancing their health through improved communication and enhanced self-management of chronic conditions. This paper describes enabling technologies in four domains (the body, the home, the community, and the primary care clinic) that can support the critical role primary care clinicians play in the health care system. It also identifies challenges to incorporating these technologies into primary care clinics, care processes, and workflow.
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Affiliation(s)
- Heather M Young
- Betty Irene Moore School of Nursing, UC Davis Health System, Sacramento, CA, 95817, USA.
| | - Thomas S Nesbitt
- UC Davis Health System, Davis, CA, USA
- Family and Community Medicine, UC Davis, Davis, CA, USA
- Center for Information Technology Research in the Interest of Society, University of California, Davis, CA, USA
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Sy W, Lamb AJ. Atopic Dermatitis Disease Education. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1027:179-184. [PMID: 29063439 DOI: 10.1007/978-3-319-64804-0_14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atopic dermatitis is a skin condition that is increasing burdensome to patient's lives. Patients require effective strategies to cope with the condition as well as the vast amount of new research that is coming to the forefront. This chapter discusses the patient education aspect of atopic dermatitis. We drew from various sources-such as peer-reviewed academic journals, online groups, and organizational websites-to provide a brief survey of the available types of patient educational resources. We discuss educational materials and interventions, such as workshops and support groups. In addition to the content of the workshops, we also explore the importance of their facilitators. We also review organizations in the US that pertain to atopic dermatitis and eczema care, such as the National Eczema Association and the American Academy of Dermatology. Lastly, we survey the role of technology-such as social media, web-based applications and teledermatology-in facilitating patient education. Despite the promising impacts of these technological interventions in the way patients consume educational materials, we also acknowledge that they are not widely used.
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Affiliation(s)
- Wayne Sy
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA
| | - Angela J Lamb
- Department of Dermatology, The Mount Sinai Hospital, New York, NY, USA.
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Caffery LJ, Farjian M, Smith AC. Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: A scoping review. J Telemed Telecare 2016; 22:504-512. [PMID: 27686648 DOI: 10.1177/1357633x16670495] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022]
Abstract
We undertook a scoping review of the published literature to identify and summarise key findings on the telehealth interventions that influence waiting times or waiting lists for specialist outpatient services. Searches were conducted to identify relevant articles. Articles were included if the telehealth intervention restructured or made the referral process more efficient. We excluded studies that simply increased capacity. Two categories of interventions were identified - electronic consultations and image-based triage. Electronic consultations are asynchronous, text-based provider-to-provider consultations. Electronic consultations have been reported to obviate the need for face-to-face appointments between the patient and the specialist in between 34-92% of cases. However, it is often reported that electronic consultations are appropriate in less than 10% of referrals for outpatient care. Image-based triage has been used successfully to reduce unnecessary or inappropriate referrals and was used most often in dermatology, ophthalmology and otolaryngology (ENT). Reported reduction rates for face-to-face appointments by specialty were: dermatology 38-88%, ophthalmology 16-48% and ENT 89%. Image-based triage can be twice as effective as non-image based triage in reducing unnecessary appointments. Telehealth interventions can effectively be used to reduce waiting lists and improve the coordination of specialist services, and should be considered in conjunction with clinical requirements.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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Łudzik J, Witkowski AM, Roterman-Konieczna I, Bassoli S, Farnetani F, Pellacani G. Improving Diagnostic Accuracy of Dermoscopically Equivocal Pink Cutaneous Lesions with Reflectance Confocal Microscopy in Telemedicine Settings: Double Reader Concordance Evaluation of 316 Cases. PLoS One 2016; 11:e0162495. [PMID: 27606812 PMCID: PMC5015858 DOI: 10.1371/journal.pone.0162495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Solitary pink lesions in differential diagnosis with hypopigmented/amelanotic melanoma present a diagnostic challenge in daily practice and are regularly referred for second expert opinion. Reflectance confocal microscopy (RCM) has been shown to improve diagnostic accuracy of dermoscopically equivocal pink lesions. No studies have been performed to evaluate the effect of adding a second expert reader and automatic removal of lesions with discordant management recommendations and its potential effect on diagnostic sensitivity and final management of these lesions in retrospective or telemedicine settings. OBJECTIVE To improve diagnostic accuracy and reduce potential mismanagement of dermoscopically equivocal pink cutaneous lesions by implementing double reader concordance evaluation of RCM images. METHODS 316 dermoscopically equivocal pink lesions with dermoscopy-RCM image sets were evaluated retrospectively. Accuracy of three readers was evaluated by single reader evaluation of dermoscopy only and dermoscopy-RCM image sets and finally by double reader evaluation of dermoscopy-RCM image sets. Lesions with discordant diagnosis between two readers were automatically recommended for excision. RESULTS Dermoscopy only evaluation resulted in an overall sensitivity of 95.9% and specificity of 33.6%, with 1 of 12 amelanotic melanomas mismanaged. Dermoscopy-RCM image set single reader evaluation resulted in an overall sensitivity of 93.9% and overall specificity of 54.2%, with 1 of 12 melanomas mismanaged. Dermoscopy-RCM image set double reader concordance evaluation resulted in an overall sensitivity of 98.3% and specificity of 42.7%, with no amelanotic melanoma mismanagement. CONCLUSION Evaluation of dermoscopy-RCM image sets of equivocal pink lesions by a single reader in telemedicine settings is limited by the potential for misdiagnosis of dangerous malignant lesions. Double reader concordance evaluation with automatic referral of lesions for removal in the case of discordant diagnosis improves the diagnostic sensitivity in this subset of lesions and reduce potential misdiagnosis in settings where a second expert opinion may be employed.
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Affiliation(s)
- J. Łudzik
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biostatistics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - A. M. Witkowski
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - I. Roterman-Konieczna
- Department of Biostatistics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - S. Bassoli
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F. Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G. Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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