Evaluación de un sistema de filtro de pacientes con lesiones pigmentadas mediante teleconsulta diferida / Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation

Introducción. Las clínicas de lesiones pigmentadas (CLP) se desarrollaron como un sistema de referencia rápida para pacientes con lesiones pigmentadas. Sin embargo, el método adecuado para la selección de pacientes que precisan atención en estas unidades no está claramente definido. La teledermatología es una herramienta cuya utilidad como sistema de selección de pacientes en las CLP precisa de evaluación. Objetivo. Evaluar la teleconsulta como sistema de filtro de pacientes con lesiones pigmentadas en términos de eficacia, exactitud y satisfacción. Método. Se evalúan las teleconsultas recibidas en una CLP en un periodo de 12 semanas. Los pacientes teleconsultados refirieron cambios en una lesión pigmentada, lesión de aparición reciente, lesiones múltiples, sintomáticas o preocupación acerca de un nevo. Se calcularon los intervalos de tiempo en remitir el informe de teleconsulta y en ser atendido en la consulta «física» de la CLP, los coeficientes k intraobservador, interobservador y con el patólogo, así como el grado de satisfacción de pacientes y médicos de atención primaria. Resultados. Se evaluaron 219 teleconsultas de las cuales el 49,3 % se derivaron a la consulta «física». El motivo más frecuente de teleconsulta fue la preocupación acerca de un nevo (37,0 %). Las teleconsultas fueron respondidas en un tiempo medio de 43,9 h, y los pacientes fueron atendidos en la consulta «física» antes de 2 semanas. La concordancia intraobservador fue de k = 0,93 (intervalo de confianza del 95 % [IC 95 %]: 0,87-0,98); concordancia interobservador k = 0,91 (IC 95 %: 0,87-0,96) y la concordancia entre el teledermatólogo y el patólogo k = 0,79 (IC 95 %: 0,70-0,89). El 86 % de los pacientes y el 91 % de los médicos de atención primaria refirieron estar «muy satisfechos» con la implantación de este nuevo sistema. Conclusiones. La teleconsulta es un sistema de filtro preciso para pacientes con lesiones pigmentadas. Mediante esta metodología, los tiempos de espera para pacientes con lesiones malignas o sospechosas de malignidad pueden ser acortados al mismo tiempo que disminuye la sobrecarga de trabajo de las CLP. Sin embargo, es necesaria una mayor experiencia para establecer la utilidad real de este sistema de filtro en el diagnóstico precoz del melanoma

Introduction. Pigmented lesion clinics (PLC's) were developed as a quick referral system for patients with pigmented lesions. However, the most appropriate method of selecting patients who need to be seen in these units is not clearly defined. Teledermatology is a tool whose usefulness as a patient selection system for PLC's needs to be evaluated. Objective. To evaluate teleconsultation as a screening system for patients with pigmented lesions in terms of efficacy, accuracy and satisfaction. Method. Teleconsultations received at a PLC over a period of 12 weeks were evaluated. Teleconsultation patients reported changes in a pigmented lesion, a lesion that had recently appeared, multiple lesions, symptomatic lesions or concern about a nevus. We calculated the time intervals in sending the teleconsultation report and in patients being seen at the «physical» PLC consultation, the intraobserver, interobserver and pathologist k coefficients, as well as the degree of satisfaction of patients and Primary Care (PC) physicians. Results. 219 teleconsultations were evaluated, 49.3 % of which were referred to the «physical» consultation. The most frequent reason for the teleconsultation was concern about a nevus (37.0 %). The teleconsultations received responses in an average time of 43.9 hours, and patients were seen at the «physical» consultation within 2 weeks. The intraobserver agreement was k = 0.93 (95 % CI 0.87-0.98); interobserver agreement, k = 0.91 (95 % CI 0.87-0.96); and the agreement between the teledermatologist and the pathologist, k = 0.79 (95 % CI 0.70-0.89). 86 % of the patients and 91 % of the Primary Care physicians said that they were «very satisfied» with the implementation of this new system. Conclusions. Teleconsultation is an accurate screening system for patients with pigmented lesions. With this methodology, waiting times for patients with malignant lesions or those suspected of malignancy can be shortened at the same time as the PLC's excess workload is decreased. However, more experience is needed to establish the true usefulness of this filtering system in the early diagnosis of melanoma

[Evaluation of a screening system for patients with pigmented lesions using store-and-forward teleconsultation]. / Evaluación de un sistema de filtro de pacientes con lesiones pigmentadas mediante teleconsulta diferida.

INTRODUCTION: Pigmented lesion clinics (PLC's) were developed as a quick referral system for patients with pigmented lesions. However, the most appropriate method of selecting patients who need to be seen in these units is not clearly defined. Teledermatology is a tool whose usefulness as a patient selection system for PLC's needs to be evaluated. OBJECTIVE: To evaluate teleconsultation as a screening system for patients with pigmented lesions in terms of efficacy, accuracy and satisfaction. METHOD: Teleconsultations received at a PLC over a period of 12 weeks were evaluated. Teleconsultation patients reported changes in a pigmented lesion, a lesion that had recently appeared, multiple lesions, symptomatic lesions or concern about a nevus. We calculated the time intervals in sending the teleconsultation report and in patients being seen at the "physical" PLC consultation, the intraobserver, interobserver and pathologist kappa coefficients, as well as the degree of satisfaction of patients and Primary Care (PC) physicians. RESULTS: 219 teleconsultations were evaluated, 49.3 % of which were referred to the "physical" consultation. The most frequent reason for the teleconsultation was concern about a nevus (37.0 %). The teleconsultations received responses in an average time of 43.9 hours, and patients were seen at the "physical" consultation within 2 weeks. The intraobserver agreement was kappa = 0.93 (95 % CI 0.87-0.98); interobserver agreement, kappa = 0.91 (95 % CI 0.87-0.96); and the agreement between the teledermatologist and the pathologist, kappa = 0.79 (95 % CI 0.70-0.89). 86 % of the patients and 91 % of the Primary Care physicians said that they were "very satisfied" with the implementation of this new system. CONCLUSIONS: Teleconsultation is an accurate screening system for patients with pigmented lesions. With this methodology, waiting times for patients with malignant lesions or those suspected of malignancy can be shortened at the same time as the PLC's excess workload is decreased. However, more experience is needed to establish the true usefulness of this filtering system in the early diagnosis of melanoma.