Waikato Teledermatology: a pilot project for improving access in New Zealand.

INTRODUCTION: Teledermatology can improve access to specialist dermatological advice. We describe a retrospective review of the first 12 months of Waikato Teledermatology (WT), a low-cost, secure, website-based, store-and-forward teledermatology network using the Collegium Telemedicus platform. METHODS: We determined specialist response time, referral metrics, patient diagnosis and progress reports from the network's database. The programme's value was evaluated by post-pilot online surveys of referrers and specialist dermatologists. RESULTS: WT was used by 31 referring doctors for 309 consultations with four dermatologists between July 2013 and June 2014. Mean and median specialist response time was 2.07 hours (range: 0.13-5.64 hours). The researchers categorized the referrals as tumours (56.8%) and rashes (43.2%), including inflammatory dermatoses (51.9%), infection (18.1%), uncertain (16.5%), miscellaneous (7.5%), and of environmental origin (6%). Thirty tumours were biopsied, including nine melanomas and three basal cell carcinomas. A total of 158 progress reports and 35 survey responses were received. Reported advantages included decreased delay, improved accuracy of diagnosis and treatment compared to that made without specialist input, decreased unnecessary procedures such as biopsies of undiagnosed conditions, and increased appropriate referrals for face-to-face assessment, thus leading to cost savings for the patient and the health care system. The major disadvantages were the time burden for clinicians to complete consultations, the lack of integration with the patients' usual electronic medical record and absence of funding. DISCUSSION: WT proved an effective and acceptable approach to improving patient access to dermatologic services.

Patients' educational needs about topical treatments for psoriasis.

BACKGROUND: Topical medications are a mainstay of psoriasis treatment. Many patients lack education about topicals. This may contribute to low adherence with long-term disease management. OBJECTIVE: We sought to describe educational needs concerning topical treatment for patients with psoriasis. METHODS: Patients' questions regarding topical therapy were collected from a National Psoriasis Foundation webcast on topical medications. The prebroadcast question responses and the postwebcast survey responses were categorized into common themes and ranked by frequency. RESULTS: Thirty percent asked about side effects, with a major emphasis on topical steroids; 16% asked about proper use; and 11% asked about efficacy. Popular new and useful education concerned specific medication facts and information on medication (especially steroid) safety, the need for treatment adherence, and the variety of options available in topical form. LIMITATIONS: The study population consisted of online users expressing interest in the National Psoriasis Foundation educational material, not the general population of patients with psoriasis. CONCLUSIONS: Patient needs can be better met by providing information regarding side effects, proper use, and efficacy of topical medications. Communication regarding treatment changes and adherence to the treatment regimen should also occur.

Who shall coordinate the coordinators? Facilitating the work of telemedicine networks which provide humanitarian services.

Telemedicine networks for humanitarian purposes have evolved over the last decade or so in a largely autonomous way. Communication between them has been informal and relatively limited in scope. This situation could be improved by developing a comprehensive approach to the collection and dissemination of information. We propose the formation of a central 'clearing house' which would allow networks to exchange information and cases where appropriate. In order for a network to belong to the clearing house, it would need to conform to certain guidelines, which would ensure that safe and satisfactory standards would be maintained. We propose that a coordinators' conference should be held to discuss who would operate the clearing house and how it would be resourced. The creation of a central clearing house would facilitate the operation of the networks, particularly during periods of heavy workload, and lead to improved sustainability, thereby benefiting individual patients. We believe that more can be achieved by the networks acting together than by them acting independently.