Teledermatology Increases Access to Care, But for Which Patients?

Doctor on the computer laptop screen.
Doctor on the computer laptop screen. Telemedicine or telehealth concept.
A study reveals which patients are benefiting most from integrating dermatologic care through a telemedicine system.

Use of telemedicine to supplement dermatologic care can improve access for underserved patients, according to study results published in the Journal of the American Academy of Dermatology. In addition, patients receiving telemedicine tend to experience reduced wait times for a follow-up in-person appointment with a specialist, if one is needed at all.

The investigators conducted a cross-sectional evaluation of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University in Columbus from January 2017 through January 2019. Ambulatory referrals included all conventional referrals to dermatology placed by an outpatient provider, while eConsults allowed outpatient providers to select a diagnosis, answer targeted questions, and send digital images using the electronic record management system to a consulting dermatologist. In addition, the investigators conducted an unplanned manual audit from January through March 2018 to examine dermatology appointment wait times and status (attended, cancelled, or “no show”).

Researchers noted that access to standard dermatologic care can be challenging due to socioeconomic and demographic disparities. Compared with ambulatory referrals, eConsults served more non-white patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P <.001) and Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P <.001). In addition, eConsults were more frequently used for men (748 of 1698 unique patients [44.1%] vs 6,480 of 16,073 [40.3%]; P =.003) and younger patients (44.6±19.7 vs 47.0±17.6 years; P <.001) than ambulatory referrals.

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The mean turnaround time from the eConsult order being placed to a dermatologist completing a teledermatology encounter was 0.46±0.69 business days. A total of 80% of patients who used eConsults did not require an in-person specialty appointment. Patients who did waited a median of 11 days between the eConsult order and their in-person dermatology visit (P <.001) compared with patients referred by conventional means who waited a median of 26 days. Ambulatory referral patients were significantly less likely to attend their scheduled appointment than either cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%], eConsult patients; P =.003), or “no shows” (246 of 2526 [9.7%] vs 3 of 62 [4.8%]).

Looking specifically at the diagnosis and management of skin cancer, the researchers found that 27 eConsult patients had a median of 26.7±37.2 days between appointment and biopsy, while 280 ambulatory referral patients waited a median of 65.4±72.5 days (P <.001). eConsult patients also waited fewer median days to extirpation (80.7±79.8 vs 116.9±86.6; P =.004).

“Through eConsults, we were able to serve a higher proportion of underserved and underinsured groups compared to conventional referrals, providing a much needed service to a more diverse patient population. Further, this population had lower appointment “no show” rates and were able to see an in-person dermatologist and undergo definitive management for skin cancer more quickly compared with conventional referrals,” the investigators concluded.

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Wang RF, Trinidad J, Lawrence J, et al. Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center [published online October 20, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.10.053