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Sauer J, Zanghi N. Response to Wang et al., "Paroxetine is an effective treatment for refractory erythema of rosacea: Primary results from the Prospective Rosacea Refractory Erythema Randomized Clinical Trial". J Am Acad Dermatol 2024; 90:e145-e146. [PMID: 38049072 DOI: 10.1016/j.jaad.2023.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 12/06/2023]
Affiliation(s)
- John Sauer
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
| | - Nicholas Zanghi
- Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey
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Echarri A, Pradera C, Molina G, Gonzalez Moure C, De las Heras C, Fraga Iriso R, Ollero V, Echevarria C, Muñiz J. Implementation of a Teledermatology Electronic Consultation Program to Improve the Care of Patients with Inflammatory Bowel Disease. TELEMEDICINE REPORTS 2024; 5:12-17. [PMID: 38469167 PMCID: PMC10927239 DOI: 10.1089/tmr.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 03/13/2024]
Abstract
Introduction Skin lesions are a common extraintestinal manifestation associated with inflammatory bowel disease (IBD), although they may also appear as a complication of IBD treatment. Prompt referral to the dermatologist can be very helpful in practice. Teledermatology complements the traditional in-person health care modality, improving access to dermatological care. Objective To evaluate the impact of a store-and-forward teledermatology electronic consultation (e-consult) program on the care of IBD patients. Methods A retrospective study assessing the outcomes of our teledermatology program over its first 2 years of implementation. Results A total of 39 consultations involving 33 patients (69.2% women, mean age 39.6 years [12-63]) were conducted. The mean number of teleconsultations was 2.8 per month in the initial implementation stage: 33 consultations were carried out in patients with Crohn's disease and 6 in ulcerative colitis. Only 18% of the patients had an active flare-up. The most frequent reason for the e-consult was paradoxical psoriasiform lesions (n = 13, 33.3%), commonly related with anti-tumor necrosis factor agents (70% of the patients) and hidradenitis suppurativa (n = 4, 10.3%). Resolution was achieved in 87% of patients, with a mean waiting time of 4.7 days (0-14). Almost all patients (97%) were satisfied with our program, and considered the referral through the program to be appropriate (92%). Best valued features were the reduced waiting time and the coordinated approach between the two departments involved. Conclusions Dermatology e-consult is an efficient and useful means of optimizing IBD patient care.
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Affiliation(s)
- Ana Echarri
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Carmen Pradera
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Gema Molina
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | | | - Cristina De las Heras
- Department of Dermatology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Rebeca Fraga Iriso
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Virginia Ollero
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Cristina Echevarria
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Javier Muñiz
- Departamento de Ciencias de la Salud e INIBIC, Universidad de A Coruña, CIBERCV, A Coruña, Spain
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Boxall C, Renz S, Eminton Z, Nuttall J, Saji A, Cluff C, Wilcox C, Muller I, Layton AM, Soulsby I, Santer M. Factors that influence women's enrolment and ongoing participation in a partially decentralised randomised controlled dermatology trial: a qualitative interview study with participants in the SAFA (Spironolactone for Adult Female Acne) trial. Trials 2023; 24:661. [PMID: 37821899 PMCID: PMC10568833 DOI: 10.1186/s13063-023-07630-4] [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: 04/26/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The use of decentralised clinical trials (which bring trials to patients through remote processes and technology versus central on-site visits) has been thought to be a potential solution to common recruitment and retention barriers. However, there is a lack of evidence to understand the experiences, needs and preferences of the public to inform trial methodologies that appeal to different populations. We report participant experiences of SAFA, a partially decentralised randomised clinical trial, to inform the methodology used in future dermatology trials that aim to appeal to women aged 18 and over. METHODS Participants of the SAFA (Spironolactone for Adult Female Acne) trial were invited to take part in a qualitative semi-structured interview to explore their experience and perspectives of taking part in the trial. Questions focused on their experience of using decentralised methods to access and enrol in the trial (e.g. social media advertising), in addition to the decentralised trial visit and data collection methods used throughout. Interviews were conducted remotely, recorded, and transcribed. Data were analysed using reflexive thematic analysis. RESULTS Twelve SAFA participants (all women, age range 22-36 years) were interviewed. Initially, participants were influenced to enrol by trusted online information, the feeling of validation the trial provided, and the convenience and flexibility offered by the decentralised methods and research staff made participants feel valued and enabled them to engage in the trial with minimal interference to existing commitments. SAFA participants were generally accepting of trial demands, such as the text-heavy paperwork and on-site visits for blood collection and highlighted several areas relevant for trial conduct going forwards including where decentralised methods may (and may not) be accepted and how trial accessibility and understanding could be improved. CONCLUSIONS The study has shown that decentralised methods used by responsive and approachable staff were widely accepted in the SAFA trial. Interviewees found the methods adopted in the SAFA trial helped the trial to fit with their needs and promoted a sense of feeling valued that encouraged ongoing trial engagement. Decentralised methods should be considered favourably when designing a dermatology trial as they can potentially enhance both recruitment and retention. TRIAL REGISTRATION NUMBER ISRCTN 12892056. Registered on October 15, 2018.
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Affiliation(s)
- Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK.
| | - Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Jacqueline Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Alan Saji
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Charlotte Cluff
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Christopher Wilcox
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
| | | | - Irene Soulsby
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
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Bourkas AN, Barone N, Bourkas MEC, Mannarino M, Fraser RDJ, Lorincz A, Wang SC, Ramirez-GarciaLuna JL. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open 2023; 13:e068207. [PMID: 37567745 PMCID: PMC10423833 DOI: 10.1136/bmjopen-2022-068207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions. DESIGN Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results. RESULTS 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology. CONCLUSIONS AND RELEVANCE Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/FJDVG.
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Affiliation(s)
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University Montreal, Montreal, Quebec, Canada
| | | | | | - Robert D J Fraser
- Nursing, Western University Arthur Labatt Family School of Nursing, London, Ontario, Canada
- Swift Medical, Toronto, Ontario, Canada
| | - Amy Lorincz
- Independent Researcher, Montreal, Qubec, Canada
| | - Sheila C Wang
- Swift Medical, Toronto, Ontario, Canada
- Dermatology, McGill University Department of Medicine, Montreal, Qubec, Canada
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Grata-Borkowska U, Sobieski M, Drobnik J, Fabich E, Bujnowska-Fedak MM. Perception and Attitude toward Teleconsultations among Different Healthcare Professionals in the Era of the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11532. [PMID: 36141806 PMCID: PMC9517420 DOI: 10.3390/ijerph191811532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Teleconsultation has become one of the most important and sometimes the only possible forms of communication between healthcare professionals (HCPs) and their patients during the COVID-19 pandemic. The perceptions and attitudes of HCPs to teleconsultations may affect the quality of the therapeutic process provided using them. Therefore, this study aimed to understand the attitudes to and perceptions of medical teleconsultation among various HCPs during the COVID-19 pandemic. We analyzed data from a dedicated questionnaire on preferences, attitudes, and opinions about teleconsultation, which was filled by 780 Polish HCPs. Most of the HCPs were doctors and nurses (69% and 19%, respectively); most of the doctors were family physicians (50.1%). During the pandemic, teleconsultation and face-to-face contact were reported as the preferred methods of providing medical services with similar frequency. Doctors and nurses displayed the most positive attitude toward teleconsultation while the paramedics and physiotherapists took the least positive view of it. The most frequently indicated ratio of the optimal number of teleconsultations to in-person visits in primary health facilities care was 20%:80%. Most HCPs appreciate the value of teleconsultation, and more than half of them are willing to continue this form of communication with the patient when necessary or desirable.
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Affiliation(s)
| | - Mateusz Sobieski
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
| | - Jarosław Drobnik
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
- Department of Epidemiology and Health Education, Wroclaw Medical University, 50-372 Wroclaw, Poland
| | - Ewa Fabich
- Jan Mikulicz-Radecki University Teaching Hospital, 50-556 Wroclaw, Poland
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Jiang SW, Flynn MS, Kwock JT, Nicholas MW. Store-and-Forward Images in Teledermatology: Narrative Literature Review. JMIR DERMATOLOGY 2022; 5:e37517. [PMID: 35891983 PMCID: PMC9302578 DOI: 10.2196/37517] [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] [Received: 02/23/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background Store-and-forward (SAF) teledermatology uses electronically stored information, including patient photographs and demographic information, for clinical decision-making asynchronous to the patient encounter. The integration of SAF teledermatology into clinical practice has been increasing in recent years, especially during the COVID-19 pandemic. Despite this growth, data regarding the outcomes of SAF teledermatology are limited. A key distinction among current literature involves comparing the quality and utility of images obtained by patients and trained clinicians, as these metrics may vary by the clinical expertise of the photographer. Objective This narrative literature review aimed to characterize the outcomes of SAF teledermatology through the lens of patient- versus clinician-initiated photography and highlight important future directions for and challenges of the field. Methods A literature search of peer-reviewed research was performed between February and April 2021. Key search terms included patient-initiated, patient-submitted, clinician-initiated, clinician-submitted, store-and-forward, asynchronous, remote, image, photograph, and teledermatology. Only studies published after 2001 in English were included. In total, 47 studies were identified from the PubMed electronic database and Google Scholar after omitting duplicate articles. Results Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility. SAF teledermatology can improve the efficiency of and access to care when photographs are taken by either clinicians or patients. The clinical outcomes of clinician-submitted images are comparable to those of in-person visits in the few studies that have investigated these outcomes. Coinciding with the onset of the COVID-19 pandemic, asynchronous teledermatology helped minimize unnecessary in-person visits in the outpatient setting, as many uncomplicated conditions could be adequately managed remotely via images captured by patients and referring clinicians. For the inpatient setting, SAF teledermatology minimized unnecessary contact during dermatology consultations, although current studies are limited by the heterogeneity of their outcomes. Conclusions In general, photographs taken by trained clinicians are higher quality and have better and more relevant diagnostic and clinical outcomes. SAF teledermatology helped clinicians avoid unnecessary physical contact with patients in the outpatient and inpatient settings during the COVID-19 pandemic. Asynchronous teledermatology will likely play a greater role in the future as SAF images become integrated into synchronous teledermatology workflows. However, the obstacles summarized in this review should be addressed before its widespread implementation into clinical practice.
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Affiliation(s)
- Simon W Jiang
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Michael Seth Flynn
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Jeffery T Kwock
- Department of Dermatology Duke University School of Medicine Durham, NC United States
| | - Matilda W Nicholas
- Department of Dermatology Duke University School of Medicine Durham, NC United States
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Kaliyadan F, A Al Ameer M, Al Ameer A, Al Alwan Q. Telemedicine Practice in Saudi Arabia During the COVID-19 Pandemic. Cureus 2020; 12:e12004. [PMID: 33457115 PMCID: PMC7797413 DOI: 10.7759/cureus.12004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The COVID-19 pandemic has led to an increased use of telemedicine. The primary objective of the study was to evaluate attitudes and behaviors of licensed physicians in the region to telemedicine. METHODOLOGY A cross-sectional design using an electronic survey as the primary tool was done. The questionnaire had a demographic component of the respondent (first part), covering age, specialty, and experience with telemedicine during the COVID pandemic, and a second part, which was in the form of a Likert scale, covering perceptions related to telemedicine. The Likert scale itself had two main areas: (1) attitudes toward telemedicine and (2) perceived barriers. RESULTS There were 392 valid responses of which 228 (58.1%) had used some form of telemedicine (other than standard phone calls) during the COVID-19 pandemic. The most common platforms used for telemedicine include WhatsApp® (211, 53.8%), Zoom® (131, 33.4%), Microsoft Teams® (27, 6.2%), Sehha App (65, 16.5%), Email (84, 21.4%). There was a strong agreement on the following statements: "Telemedicine can reduce unnecessary outpatient visits" (87.5%), "Effectiveness of telemedicine depends on the specialty" (89.5%), and "Telemedicine can be used to monitor chronic patients from home" (88.3%). Concerning the barriers to telemedicine, the ones having the most concordance were technological limitations (66.6%) and concerns of diagnostic reliability (66.1%). CONCLUSIONS The responses from our study seem to suggest that while the attitudes toward telemedicine are positive, practicing physicians are concerned about a perceived lack of clarity regarding related legal frameworks and barriers such as technological issues, cultural factors, and diagnostic concordance.
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Affiliation(s)
| | | | - Ali Al Ameer
- Dermatology, King Fahad General Hospital, Hofuf, SAU
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Retrospective study of trends in dermatology telemedicine and in-person visits at an academic center during COVID-19. J Am Acad Dermatol 2020; 84:777-779. [PMID: 33221466 PMCID: PMC7832782 DOI: 10.1016/j.jaad.2020.11.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/21/2022]
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