Impact of teledermatology on the accessibility and efficiency of dermatology care in an urban safety-net hospital: A pre-post analysis - 18/10/19

Doi : 10.1016/j.jaad.2019.08.016

Adam Zakaria, BA ^a, Toby Maurer, MD ^b,^c, George Su, MD ^c,^d, Erin Amerson, MD ^b,^c,^⁎
^a School of Medicine, University of California, San Francisco, San Francisco, California
^b Department of Dermatology, University of California, San Francisco, San Francisco, California
^c Zuckerberg San Francisco General Hospital, San Francisco, California
^d Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, California

^∗Correspondence to: Erin Amerson, MD, 1701 Divisadero St, San Francisco, CA 94115.1701 Divisadero StSan FranciscoCA94122

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Abstract

Background

Teledermatology enables dermatologists to remotely triage and evaluate dermatology patients, but previous studies have questioned whether teledermatology is clinically efficient.

Objective

To determine whether implementation of a teledermatology system at the Zuckerberg San Francisco General Hospital and Trauma Center has improved the accessibility and efficiency of dermatology care delivery.

Methods

Retrospective, pre-post analysis of a pre-teledermatology cohort (June 2014-December 2014) compared with a post-teledermatology cohort (June 2017-December 2017).

Results

Our analysis captured 11,586 patients. After implementation of teledermatology, waiting times for new patients decreased significantly (84.6 days vs 6.7 days; P < .001), total cases evaluated per month increased significantly (754 vs 901; P = .008), and number of cases evaluated per dermatologist-hour increased significantly (2.27 vs 2.63; P = .010). In the post-teledermatology period, 61.8% of teledermatology consults were managed without a clinic visit.

Limitations

We were unable to control for changes in demand for dermatology evaluations between the 2 periods and did not have a control group with which to compare our results.

Conclusion

The dermatology service was more accessible and more efficient after implementation of teledermatology, suggesting that capitated health care settings can benefit from implementation of a teledermatology system.

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Key words : access, appointments avoided, efficiency, store-and-forward, teledermatology, telehealth, telemedicine, underserved populations

Abbreviations used : CI, TNAA, ZSFG