Evaluation of teledermatology during a pandemic indicates high patient satisfaction, positive impact on patient-related costs and clinical effectiveness

Aim: Telehealth is becoming an increasingly important way of delivering health services accelerated by the COVID-19 pandemic. The aim of the study is to evaluate teledermatology by assessing patient satisfaction, patientrelated costs and clinical effectiveness. Method: This was a single-centre cross-sectional study. A three-part questionnaire-Dermatology life quality index (DLQI), patient satisfaction questionnaire (PSQ) and cost evaluation questionnaire-was sent out to all teledermatology patients attending the Royal Melbourne Hospital. The Spearman rank-order correlation coefficient was used to measure the association between the DLQI and PSQ. We evaluated the clinical effectiveness in psoriasis patients on biologic therapy as a sub-cohort by comparing PASI and DLQI pre and post implementation of teledermatology, using Wilcoxon signed-rank test. Results: 191/747 patients responded (51% male, 73% living in metropolitan victoria). The mean DLQI was 5.2 +/- 6.25. PSQ was divided into four categories (Positive attitude, hotel, photo anxiety and interaction). There is a negative correlation between DLQI and PSQ, with all categories showing significant correlation except the 'positive attitude' category. Analysis of the cost evaluation questionnaire showed that a majority of patients reported that telehealth appointments save time (99%), reduce time off work (41%) and help avoid costs of transport (96%). When assessing patients with psoriasis on biologic therapy, there was no significant difference in PASI scores before (mean of 1.59) and after (mean of 1.44) implementation of teledermatology (p-value 0.542). There was a significant reduction in DLQI in 59 psoriasis patients on biologic therapy, as an indicator of clinical effectiveness. The mean DLQI before implementation of teledermatology was 2.73 and after implementation was 1.69 (p-value 0.0126). Conclusions: Overall this study indicates high patient satisfaction, positive impact on patient-related costs and good clinical effectiveness of teledermatology which warrant further evaluation in larger prospective studies.