Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting - 16/02/16
Abstract |
Background |
The clinical value of teledermatology in the primary care setting remains relatively unknown.
Objective |
We sought to determine the impact of teledermatology on outpatient diagnosis, management, and access to dermatologic care in a resource-poor primary care setting.
Methods |
We performed a prospective study of store-and-forward teledermatology consults submitted between January and November 2013 from 11 underserved clinics in Philadelphia to the University of Pennsylvania using mobile devices and the Internet. We assessed diagnostic and management concordance between primary care providers and dermatologists, time to consult completion, anticipated level of dermatology input in the absence of teledermatology, and number of consults managed with teledermatology alone.
Results |
The study included 196 consults encompassing 206 dermatologic conditions. Diagnoses and management plans of primary care providers and dermatologists were fully concordant for 22% and 23% of conditions, respectively. The median time to consult completion was 14 (interquartile range 3-28) hours. At least 61% of consults would not otherwise have received dermatology input, and 77% of consults were managed with teledermatology alone.
Limitations |
Lack of a diagnostic gold standard, limited patient follow-up, and uncertain generalizability are limitations.
Conclusion |
Teledermatology is an innovative and impactful modality for delivering dermatologic care to outpatients in resource-poor primary care settings.
Le texte complet de cet article est disponible en PDF.Key words : health care access, mobile, outpatient dermatology consultation, store-and-forward, technology, teledermatology, telemedicine
Abbreviations used : AAD, PCP, PDPH, SAF
Plan
| Supported by a Bertha Dagan Berman Award for a FOCUS on Health and Leadership for Women Medical Student Fellowship; Dermatology Research Training Grant, National Institute of Arthritis And Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH), Award Number T32AR007465; and Penn Medicine Community Activity Reporting E-nitiative Foundation Grant awarded to Caroline A. Nelson and Carrie L. Kovarik. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Funding sources had no role in the design and conduct of the study; in the collection, analysis, and interpretation of data; or in the preparation, review, or approval of the manuscript. |
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| Disclosure: The American Academy of Dermatology's AccessDerm program (accessderm.aad.org) and this research study are made possible by the Vignet (www.vignetcorp.com) teledermatology technology platform. The Vignet Corporation provided the AccessDerm software and assistance with technical support. Drs Nelson, Takeshita, Wanat, James, and Kovarik were involved in the creation of the mobile platform, however, they have no institutional or corporate affiliations or any associations that might pose a conflict of interest. Dr Takeshita has a grant from Pfizer and received payment for continuing medical education work related to psoriasis. Drs Bream, Holmes, Koenig, Roth, and Vuppalapati had no role in the creation of the mobile platform and have no conflicts of interest to declare. For further information about AccessDerm, please visit accessderm-teledermatology-program. |
Vol 74 - N° 3
P. 484 - mars 2016 Retour au numéro
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