In medically underserved populations, the use of electronic consultations (eConsults) provides an effective, efficient way of circumventing the limited access to dermatologic care among these patients, allowing them to receive medical care in their own communities and enhancing skin cancer screening and treatment, according to the results of a recent retrospective cohort study published in the Journal of the American Academy of Dermatology.
The objective of the current study was to evaluate the effect of implementing a teledermatology program with dermoscopy on a statewide scale, with a focus on access to care and skin cancer identification and treatment among medically disadvantaged populations. A total of 2385 dermatology referrals from primary care were reported between June 2014 and November 2015. Overall, there were 1258 consults in the pre-eConsult period and 1127 in the post-eConsult period.
Before the use of eConsults, access to dermatology care had been limited in these patients, with only 11% (139 of 1258) of referrals resulting in a confirmed appointment with a dermatologist, with a median wait time of 77 days. In contrast, after the implementation of eConsults, 48.8% (550 of 1127) of the participants received a diagnosis or a treatment plan. Of these, 16.3% (51 of 312) required a confirmed visit, with a median wait time of 28 days.
A total of 10 malignancies were identified with the use of eConsults. The volume of consultations remained stable pre-eConsult and post-eConsult implementation. Because eConsults were evaluated in medically underserved populations who are seeking care at community health centers, the results might not be generalizable to other populations or in other settings.
The investigators concluded that eConsults do increase access to dermatologic care and reduce patient wait times among those receiving medical care at community health centers. The implementation of dermoscopy into teledermatology can help decrease no-show rates among medically disadvantaged patients.
Naka F, Lu J, Porto A, Villagra J, Wu ZH, Anderson D. Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: a model for teledermatology services in community health centers [published online October 20, 2017]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2017.09.017