ABSTRACT
Background: The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient's skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. Objective: The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. Methods: We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. Results: In total, 5717 unique patients completed at least 1 teledermatology visit during the study period;68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. Conclusions: Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care. ©Jordan E Lamb, Robert Fitzsimmons, Anjana Sevagamoorthy, Carrie L Kovarik, Daniel B Shin, Junko Takeshita. Originally.
ABSTRACT
The COVID-19 pandemic has been a catalyst in the slow-moving transition to telemedicine services: dermatology has been particularly affected by this move to 'teledermatology' and the use of virtual clinics. However, the COVID-19 pandemic has also exposed and exacerbated pre-existing health inequalities. Dermatological services are prone to inequalities in service access, disease burden and equity. There are 13 million general practice consultations for skin conditions every year (https://www.not tingham.ac.uk/research/groups/cebd/documents/hcnaskinc onditionsuk2009.pdf), yet only 611 dermatology consultants provide specialist care (https://www.statista.com/statistics/ 594431/dermatologists-in-the-united-kingdom-uk-by-staffgrade/). Teledermatology with the adoption of virtual clinics has the potential to increase accessibility to dermatology patients in geographically isolated areas. However, access and use of virtual clinics for dermatology patients poses several challenges. In 2018, five million people in the UK were noninternet users (https://www.ons.gov.uk/peoplepopulationa ndcommunity/householdcharacteristics/homeinternetandsoc ialmediausage/articles/exploringtheuksdigitaldivide/2019-03-04). A geographical divide exists in the UK concerning knowledge and application of basic digital skills, with the North, the Midlands and Wales falling short in a national average of 79%. The Department for Work and Pensions has impairment listings on a range of skin conditions that are most likely to be disabling (https://www.gov.uk/governme nt/publications/medical-guidance-for-dla-and-aa-decision-ma kers-adult-cases-staff-guide). Yet, 22% of all disabled people lack internet access. Ethnic disparities on the use of pre-existing online healthcare infrastructure like NHS Direct already exist (Cook EJ, Randhawa G, Large S et al. Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare. Int J Equity Health 2014;13: 99). Cultural factors and those living in overcrowded housing lack the privacy needed for dermatological consultations. With austerity measures, people are unable to afford internet access or goodquality computers to make video calls to talk about their skin problems, making teledermatology an unsuitable alternative. The digital divide also exists across an age gradient, with older people more likely to report not using the internet. Dermatology patients tend to be elderly, with the median age of patients referred being 51 years. With virtual clinics projected to be significant in the future delivery of dermatology services, it would be prudent to mitigate the risks of digital exclusion for our most vulnerable patients and tackle the persisting inequalities.
ABSTRACT
Telemedicine is increasingly being used as a means of triaging referrals, educating primary care physicians and - in some circumstances - replacing face-to-face appointments. Since the start of the COVID-19 pandemic, its use has exponentially risen. It is vital to consider how clinicians are taught to practice this form of medicine, as it is significantly different from 'routine clinical practice'. This review aimed to consider the current evidence for the methods used when teaching telemedicine and, more specifically, teledermatology and the effectiveness of these methods. Database searches were conducted in MEDLINE, Embase, Web of Science and Education Research Complete. Search terms related to telemedicine/teledermatology and education/learning were used. Titles and s were independently screened by two reviewers according to the eligibility criteria, followed by the full texts. Results were extracted and analysed thematically. Critical appraisal was undertaken. Eleven studies were included in the review from the 451 identified. Some studies were poorly designed and open to sources of bias, confounding factors and limited reliability. Teaching methods identified included continuous feedback to trainees, training via an online platform, reviewing prior exposure to telemedicine and different telemedicine modalities (still photographs vs. videos). Four themes were identified in the results of the papers: concordance rates between clinicians, knowledge acquisition, clinician confidence and its use as an educational tool. Multiple methods of telemedicine education are used. Generally, trainees that have more exposure to it are more confident in undertaking it in ongoing clinical practice. There is evidence that there is an element of knowledge acquisition associated with tele-education, but that it is not necessarily sustained long term. The use of videos to supplement still images in consultations appears to be superior. Future work to assess the effectiveness of different teaching methods should be considered a priority with the explosion of telemedicine undertaken since the start of the COVID-19 pandemic.
ABSTRACT
BACKGROUND: The COVID-19 pandemic has shifted healthcare from physical in-person patient visits to teleconsultations in order to curtail the spread of this virus. Dermatology, being a visual science, lends itself amenably to teleconsultation. OBJECTIVE: This study was performed to assess the basic dermatological diseases which are more easily diagnosable and managed through teleconsultation, distinguishing them from diseases for which a face-to-face consultation may be a better option and to delineate the factors affecting the image quality which is the cornerstone of a teledermatology consultation. METHODS: A retrospective observational study was conducted over a three-month period during the pandemic. Store and forward, video conferencing, and hybrid consultations were included. Two dermatologists of different clinical experience independently assessed the clinical photographs of the patients and gave each photograph an objective score (Physician Quality Rating Scale) and a diagnosis. The diagnostic concordance between the two dermatologists as well as the correlation of this score with the certainty of diagnosis was calculated. RESULTS: A total of 651 patients completed the study. Mean PQRS score of Dermatologist 1 was 6.22 while the mean score of Dermatologist 2 was 6.24. Patients in whom both the dermatologists were absolutely certain about their diagnosis had a higher PQRS score and interestingly had a higher education level than the rest. There was 97.7 percent diagnostic concordance between the two dermatologists. Infections, acne, follicular disorders, pigmentary disorders, tumors, and STDs had the largest proportion of cases wherein both the dermatologists were in total agreement with each other. CONCLUSION: Teledermatology might be best for the care of patients with characteristic clinical presentation or for follow-up of already diagnosed patients. It can be used in the post-COVID era to triage patients requiring emergency care and reduce patient wait times. [ABSTRACT FROM AUTHOR] Copyright of Journal of Clinical & Aesthetic Dermatology is the property of Matrix Medical Communications, LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)