Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic-based care.
ABSTRACT We compared the clinical outcomes after store-and-forward teledermatology with those following conventional clinic-based consultation. Subjects were randomized to either usual care (a conventional clinic-based dermatology appointment) or a store-and-forward teledermatology consultation. All subjects received baseline digital imaging and re-imaging was performed four months later. A total of 776 subjects were approached for inclusion, and a total of 508 image sets were reviewed, 236 in usual care and 272 in teledermatology. The image sets from both study arms were used to make clinical outcome assessments between baseline and four months. A dermatologist who was blinded to the randomization rated the clinical outcomes using a three-point clinical course rating scale (1 = improved, 2 = no change, 3 = worse). In the usual care group, 65% were rated as 'improved', 32% were rated as 'no change' and 3% were rated as 'worse'. For teledermatology, 64% were rated as 'improved', 33% as 'no change' and 4% as 'worse'. The results of the study indicate that store-and-forward teledermatology consultations produce similar clinical outcomes when compared with conventional clinic-based consultations.
- SourceAvailable from: April Wang Armstrong[show abstract] [hide abstract]
ABSTRACT: Despite increasing practice of teledermatology in the U.S., teledermatology practice models and real-world challenges are rarely studied. The primary objective was to examine teledermatology practice models and shared challenges among teledermatologists in California, focusing on practice operations, reimbursement considerations, barriers to sustainability, and incentives. We conducted in-depth interviews with teledermatologists that practiced store-and-forward or live-interactive teledermatology from January 1, 2007 through March 30, 2011 in California. Seventeen teledermatologists from academia, private practice, health maintenance organizations, and county settings participated in the study. Among them, 76% practiced store-and-forward only, 6% practiced live-interactive only, and 18% practiced both modalities. Only 29% received structured training in teledermatology. The average number of years practicing teledermatology was 4.29 years (SD±2.81). Approximately 47% of teledermatologists served at least one Federally Qualified Health Center. Over 75% of patients seen via teledermatology were at or below 200% federal poverty level and usually lived in rural regions without dermatologist access. Practice challenges were identified in the following areas. Teledermatologists faced delays in reimbursements and non-reimbursement of teledermatology services. The primary reason for operational inefficiency was poor image quality and/or inadequate history. Costly and inefficient software platforms and lack of communication with referring providers also presented barriers. Teledermatology enables underserved populations to access specialty care. Improvements in reimbursement mechanisms, efficient technology platforms, communication with referring providers, and teledermatology training are necessary to support sustainable practices.PLoS ONE 01/2011; 6(12):e28687. · 3.73 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: The expansion of store-and-forward teledermatology into underserved regions of the world has long been hampered by the requirement for computers with Internet connectivity. To our knowledge, this study is one of the first to demonstrate the feasibility of teledermatology using newer-generation mobile telephones with specialized software and wireless connectivity to overcome this requirement in a developing country. We sought to demonstrate that mobile telephones may be used on the African continent to submit both patient history and clinical photographs wirelessly to remote expert dermatologists, and to assess whether these data are diagnostically reliable. Thirty patients with common skin diseases in Cairo, Egypt, were given a diagnosis by face-to-face consultation. They were then given a diagnosis independently by local senior dermatologists using teleconsultation with a software-enabled mobile telephone containing a 5-megapixel camera. Diagnostic concordance rates between face-to-face and teleconsultation were tabulated. Diagnostic agreement between face-to-face consultation and the two local senior dermatologists performing independent evaluation by teleconsultation was achieved in 23 of 30 (77%) and in 22 of 30 (73%) cases, respectively, with a global mean of 75%. Limited sample size and interobserver variability are limitations. Mobile teledermatology is a technically feasible and diagnostically reliable method of amplifying access to dermatologic expertise in poorer regions of the globe where access to computers with Internet connectivity is unreliable or insufficient.Journal of the American Academy of Dermatology 02/2011; 64(2):302-9. · 4.91 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Telemedicine holds promise as a tool for improving the delivery of specialty care, especially in underserved regions, including those in South Africa. However, data that demonstrate the extent of its sustainable benefits to referring providers are currently insufficient. This study investigates whether utilization of a teledermatology network enhances the diagnostic acumen of primary care providers (PCPs) in underserved areas of South Africa. A longitudinal descriptive pilot study was conducted after establishing a telemedicine network linking University of Cape Town dermatology consultants to six providers from five underserved primary care sites using store-and-forward technology between October 2004 and January 2007. Of 120 total referrals, trend analysis was performed using 72 sets of patient histories, digital images, and corresponding consultant responses to evaluate the diagnostic concordance between six PCPs and teleconsultants over 12 consecutive referrals. Strong positive Spearman rank-order correlations were observed between the number of referrals sent per PCP and proportion of primary diagnostic agreement with teledermatologists, rs=0.86 (p <0.001). The mean primary diagnostic concordance trend that started at 13% for the first four referrals increased nearly fourfold after referring as few as nine patients to the network. If a simple and inexpensive teledermatology solution is carefully implemented in a resource-limited setting, an improvement of PCP diagnostic acumen can be achieved with a relatively small number of referrals. This educational benefit to referring PCPs could be sustainable and would ultimately enhance the quality of dermatological care in these underserved regions.Telemedicine and e-Health 06/2011; 17(5):363-9. · 1.40 Impact Factor