ABSTRACT
BACKGROUND: Studies suggest potential heterogeneity in telemedicine adoption with potential to exacerbate healthcare access inequity. METHODS: A pre-validated survey was electronically sent to a proprietary listserv of practicing US-based dermatologists. Results were stratified by when teledermatology was adopted. Chi-square and odds ratios (OR) with 95% confidence intervals (95%CI) were used to analyze categorical data while single-factor ANOVA with posthoc Tukey-Kramer was used for continuous data. RESULTS: 338 practicing US-based dermatologists completed the questionnaire. Academic/Government dermatologists were 4-times more likely (OR 4.08, 95%CI 2.37-7.03) to adopt teledermatology pre-COVID than private-practice dermatologists. Dermatologists with ≤10 years of experience were 1.8-times (OR 1.8, 95%CI 1.01-3.18) and 2.82-times more likely (OR 2.82, 95%CI 0.78-10.25) to adopt teledermatology pre-COVID-19 or at all, respectively, compared to dermatologists with ≥20 years of experience. Teledermatology adopters practiced more medical-dermatology (P<.0001) than non-adopters, who reported practicing more dermatologic surgery (P=.003; Tukey-Kramer α<.05) and dermatopathology (P<.0001; Tukey-Kramer α<.05). Pre-COVID-19 adopters were 4-times more likely (OR 4.69, 95%CI 1.46-15.07) to switch/incorporate live-interactive-only teledermatology (LI) post-COVID-19. Post-COVID-19 adopters were 6-times more likely (OR 6.09, 95%CI 3.36-11.06) to utilize LI than Pre-COVID-19 adopters. Pre-COVID-19 adopters use teledermatology for a larger proportion of patient visits than Post-COVID-19 adopters (19.6% v 10.4%, P<.0001), but also are 3.43-times more likely (OR 3.43, 95%CI 1.82-6.46) to report future decreases in usage. LIMITATIONS: Cross-sectional retrospective survey and potential response bias. CONCLUSION: Current teledermatology usage may be a suitable tool for medical-dermatology-focused practices. Material hurdles still exist for procedurally-oriented practices and future studies should investigate these barriers to maximize equitable access to dermatological care. J Drugs Dermatol. 2023;21(1):101-104. doi:10.36849/JDD.7169.
Subject(s)
COVID-19 , Dermatology , Skin Diseases , Humans , United States/epidemiology , Dermatology/methods , Cross-Sectional Studies , Retrospective Studies , COVID-19/diagnosis , COVID-19/epidemiology , Health Services Accessibility , Skin Diseases/diagnosis , Skin Diseases/epidemiology , Skin Diseases/therapySubject(s)
COVID-19 , Melanoma , Cohort Studies , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Pandemics/prevention & control , SARS-CoV-2Subject(s)
Dermatology , Skin Diseases , Telemedicine , Dermatologists , Humans , Skin Diseases/diagnosis , Skin Diseases/therapySubject(s)
COVID-19/prevention & control , Dermatology/statistics & numerical data , Remote Consultation/statistics & numerical data , Skin Diseases/therapy , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Communicable Disease Control/standards , Dermatologists/statistics & numerical data , Dermatology/organization & administration , Dermatology/standards , Disease Progression , Faculty/statistics & numerical data , Hospitals, Teaching/organization & administration , Hospitals, Teaching/standards , Hospitals, Teaching/statistics & numerical data , Humans , Pandemics/prevention & control , Patient Satisfaction/statistics & numerical data , Quality of Health Care , Remote Consultation/organization & administration , Remote Consultation/standards , SARS-CoV-2/pathogenicity , Skin Diseases/diagnosis , Surveys and Questionnaires/statistics & numerical data , Time Factors , Time-to-TreatmentSubject(s)
Betacoronavirus , Coronavirus Infections , Exanthema , Pandemics , Pneumonia, Viral , COVID-19 , Humans , SARS-CoV-2ABSTRACT
OBJECTIVE: To describe and evaluate a risk-stratified triage pathway for inpatient urology consultations during the SARS-CoV-2 (COVID-19) pandemic. This pathway seeks to outline a urology patient care strategy that reduces the transmission risk to both healthcare providers and patients, reduces the healthcare burden, and maintains appropriate patient care. MATERIALS AND METHODS: Consultations to the urology service during a 3-week period (March 16 to April 2, 2020) were triaged and managed via one of 3 pathways: Standard, Telemedicine, or High-Risk. Standard consults were in-person consults with non COVID-19 patients, High-Risk consults were in-person consults with COVID-19 positive/suspected patients, and Telemedicine consults were telephonic consults for low-acuity urologic issues in either group of patients. Patient demographics, consultation parameters and consultation outcomes were compared to consultations from the month of March 2019. Categorical variables were compared using Chi-square test and continuous variables using Mann-Whitney U test. A P value <.05 was considered significant. RESULTS: Between March 16 and April 2, 2020, 53 inpatient consultations were performed. By following our triage pathway, a total of 19/53 consultations (35.8%) were performed via Telemedicine with no in-person exposure, 10/53 consultations (18.9%) were High-Risk, in which we strictly controlled the urology team member in-person contact, and the remainder, 24/53 consultations (45.2%), were performed as Standard in-person encounters. COVID-19 associated consultations represented 18/53 (34.0%) of all consultations during this period, and of these, 8/18 (44.4%) were managed successfully via Telemedicine alone. No team member developed COVID-19 infection. CONCLUSION: During the COVID-19 pandemic, most urology consultations can be managed in a patient and physician safety-conscious manner, by implementing a novel triage pathway.