1
|
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.
Collapse
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
| |
Collapse
|
2
|
Gatica JL, Aragón-Caqueo D, Aedo G, Fuenzalida H, Loubies R, Aedo S, Carrasco MF, Sabando V, Cunill C, Letelier MJ. Teledermatology Evaluation and Feedback Systems: A Tool for Improving Care. Healthcare (Basel) 2023; 11:healthcare11111626. [PMID: 37297766 DOI: 10.3390/healthcare11111626] [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: 05/11/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Chile is a country where teledermatology has been growing exponentially since the implementation of a single national asynchronous teledermatology platform for the public system in December 2018. To ensure the quality of care in teledermatology systems, it is crucial to evaluate the fulfillment of basic specifiers such as ICD-Diagnosis, therapeutic suggestions, and diagnostic suggestions, among others. This article aims to evaluate the teledermatology system of the Chilean public health service by analyzing 243 randomly extracted consultations, representative of the 20,716 electronic consultations performed during 2020. Compliance with basic specifiers is evaluated. From these, fulfillment of core teledermatology functions, such as diagnostic and therapeutic suggestions, is observed in most consultations. There are statistically significant relationships between the patient's destination (primary health center [PHC] or face-to-face referral), pharmacological prescription, coverage of the drug prescribed by the public system, and the education received by the consulting physician. If the consultation is resolved in the PHC, there is a higher chance for pharmacological prescription, prescribing mostly drugs that are covered by the government. This is less likely to occur when patients are referred for face-to-face evaluation. A targeted evaluation of education, pharmacological prescriptions, and their applicability is key to improving the quality of teledermatology systems.
Collapse
Affiliation(s)
- José Luis Gatica
- Hospital Digital, Célula de Teledermatología, Ministerio de Salud de Chile, Santiago 8320218, Chile
| | | | - Gabriel Aedo
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile
| | - Héctor Fuenzalida
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile
| | - Rodrigo Loubies
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile
| | - Sócrates Aedo
- Escuela de Medicina, Facultad de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile
| | - María Francisca Carrasco
- Hospital Digital, Célula de Teledermatología, Ministerio de Salud de Chile, Santiago 8320218, Chile
| | - Vezna Sabando
- Hospital Digital, Célula de Teledermatología, Ministerio de Salud de Chile, Santiago 8320218, Chile
| | - Carolina Cunill
- Hospital Digital, Célula de Teledermatología, Ministerio de Salud de Chile, Santiago 8320218, Chile
| | - María José Letelier
- Hospital Digital, Célula de Teledermatología, Ministerio de Salud de Chile, Santiago 8320218, Chile
| |
Collapse
|
3
|
Patel H, Revankar R, Valliani A, Revankar N, Yerigeri S, Kaskas N, Stoff B. Teledermatology in medical student, postgraduate trainee, and global dermatology education: A systematic review. JAAD Int 2023; 11:106-111. [PMID: 36941913 PMCID: PMC10018315 DOI: 10.1016/j.jdin.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/22/2023] Open
Abstract
Background In the aftermath of the COVID-19 pandemic, medical students and residents in the U.S. and globally have gained more exposure to teledermatology, both for the purposes of clinical practice and education. Objective We conducted a systematic review to assess outcomes from teledermatology interventions for dermatology trainees in the U.S. and globally in accordance with Preferred Reporting Items for Systematic Reviews (PRISMA). Methods We searched MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL for articles written in English and published database inception to November 20, 2022. Results In total, 15 studies met the inclusion criteria. Outcomes reported ranged broadly from resident-provider concordance rates, diagnostic accuracy in comparison to control groups, number of patients seen, and self-reported satisfaction and improvement. Generally, studies indicated high satisfaction rates and improvement in educational outcomes among medical students, residents, and other trainees in the global health setting. Limitations Because of the heterogeneity of study design and outcomes reported, meta-analysis could not be performed. Conclusion Teledermatology can be successfully deployed for clinical care and education domestically and in the global health setting.
Collapse
Affiliation(s)
- Heli Patel
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia
| | | | - Aly Valliani
- The Icahn School of Medicine at Mount Sinai, New York
| | - Nikita Revankar
- East Carolina University Brody School of Medicine, Greenville, North Carolina
| | | | - Nadine Kaskas
- The Icahn School of Medicine at Mount Sinai, New York
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
4
|
Teaching dermatology in the era of digital technology. Ann Dermatol Venereol 2022; 149:276-278. [PMID: 35750511 DOI: 10.1016/j.annder.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 04/01/2022] [Indexed: 12/30/2022]
|
5
|
Salava A, Salmela V. Perceptual learning modules in undergraduate dermatology teaching. Clin Exp Dermatol 2022; 47:2159-2165. [PMID: 35340060 PMCID: PMC10084265 DOI: 10.1111/ced.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatologic diagnosis depends highly on visual skills and implicit non-analytical proficiency plays a key role. OBJECTIVES To investigate the effectiveness of digital perceptual learning modules (PLMs) in undergraduate teaching. METHODS The study cohort included 39 students of an undergraduate dermatology course. Online PLMs designed for dermatology were carried out three times: before, during and at the end of the course. The modules provided four outcome measures: percentage of correct responses, response/decision time, list of features that the decision was based on and confidence rating. RESULTS Diagnostic accuracy increased significantly from 66 to 94% (p< .001, η2 p =0.92), fluency improved, and response times decreased from 10 to 6 seconds (p< .001, η2 p =0.69), and self-perceived confidence increased from 2.5 to 4.3 (p< .001, η2 p =0.86) with subsequent PLMs and course duration. There was a diversification of recognized features, an increase in pattern recognition and attention to localization and contextual association. Based on student feedback, PLMs functioned well and enhanced motivation and learning. CONCLUSION PLMs increase diagnostic accuracy, had a positive effect on learning outcomes and were easily integrated side-by-side with clinical teachings. Considering our current era of digital technologies, we believe that there is potential for a wider use of PLMs to improve visual skills and strengthen implicit learning in dermatology.
Collapse
Affiliation(s)
- Alexander Salava
- Department of Dermatology, Venereology and Allergology, University of Helsinki, Meilahdentie 2, 00250, Helsinki, Finland
| | - Viljami Salmela
- Department of Psychology and Logopedics, University of Helsinki, Haartmaninkatu 3, 00290, Helsinki, Finland
| |
Collapse
|
6
|
Lam M, Doiron PR. The Use of Teledermatology in Medical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:243-246. [PMID: 34815891 PMCID: PMC8601370 DOI: 10.1007/s40670-021-01465-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
Certain aspects of medical education have transitioned to virtual platforms since the start of the COVID-19 pandemic. This commentary explores advantages and barriers to teledermatology in medical education, which has the potential to reach an extensive pool of learners and preceptors but may be limited by logistical and security considerations of a virtual platform. Dermatology in particular lends itself to an online platform as a highly visual specialty, although clinical exam would be highly dependent on quality of images captured. With teledermatology, learners can begin developing an approach to delivering care remotely, and becoming accustomed to virtual platforms.
Collapse
Affiliation(s)
- Megan Lam
- Michael G. DeGroote School of Medicine, Faculty of Medicine, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4L8 Canada
| | - Philip R. Doiron
- Division of Dermatology, Women’s College Hospital, Toronto, ON Canada
| |
Collapse
|
7
|
Affiliation(s)
- Chee Hoou Loh
- Department of Dermatology, Singapore General Hospital
| | - Felicia Ong
- Department of Dermatology, Singapore General Hospital
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital.,Duke-NUS Medical School
| |
Collapse
|
8
|
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: 11] [Impact Index Per Article: 3.7] [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.
Collapse
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
| |
Collapse
|