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Teledermatology Aids in Triage, Access, and Educating PCPs

Teledermatology can not only improve access to care and patient outcomes, but it can also help reduce costs, help improve diagnostic accuracy, and aid busy primary care physicians (PCPs), said Robert R. Stavert, MD, MBA, from Harvard Medical School and Beth Israel Deaconess Medical Center, at the 2019 American Academy of Dermatology Summer Meeting.1

Dr Stavert discussed teledermatology experiences in his own practice as an example. After receiving a referral to the teledermatology service from a PCP, patients can use a HIPAA-compliant phone application to electronically transmit photos of their dermatologic health concerns to their electronic medical records. Teledermatologists attempt to respond to all submissions within 24 to 48 hours and send diagnostic and treatment information back to patients’ referring PCPs, who are then responsible for conveying instructions and any prescription information to patients.

To date, Dr Stavert’s practice has completed over 7000 consults, with 270 unique providers submitting referrals. Of these patients, 60% were women, 60% were on Medicaid, and 50% of referrals were for cases of rashes and/or inflammatory conditions. Photos sent by patients were deemed adequate in approximately 90% of cases.

Importantly, this service has shown high levels of diagnostic and management concordance between teledermatology and in-person visits, as well as high levels of discordance between referring providers and dermatologists.

“What this means is that in the majority of cases that we received, the teledermatologist disagreed with either the presumed diagnosis or management plan of the referring provider, and I think that’s telling us that these consults were really adding a lot of value and changing the course of the patient’s condition” said Dr Stavert.

The teledermatology service has aided in triaging cases and promoting appointment completion among patients. Approximately 63% of patients using the service were able to avoid an initial visit. Teledermatology patients were found to complete appointments twice as often as those who received routine in-person referrals, and a total of 75 skin cancers were diagnosed through the service.

Furthermore, in a recent study, Dr Stavert and colleagues found that referring providers benefitted from the teledermatology service as well, noting that many PCPs demonstrated a measurable difference in dermatologic knowledge after 1 year of participation.2

“This difference correlated with how frequently they were using the service,” Dr Stavert noted. “That was really encouraging to us because one of our goals was to improve education that we’re offering our primary care colleagues,” he said.

Dr Stavert concluded his session by naming 3 key clinical takeaways:

  • Patients in safety net systems often have difficulty accessing dermatologic care.
  • Teledermatology can help increase dermatologic knowledge among referring PCPs and can have a meaningful clinical impact among patients.
  • Teledermatology can help triage patients and improve access to dermatologic expertise.

—Christina Vogt

References:

1. Stavert RR, Asai E, Das S. Teledermatology. Presented at: 2019 American Academy of Dermatology Summer Meeting; July 25, 2019; New York, NY. https://www.aad.org/scientificsessions/sam2019/SessionDetails.aspx?id=12768.

2. Mohan GC, Molina GE, Stavert R. Store and forward teledermatology improves dermatology knowledge among referring primary care providers: A survey-based cohort study. J Am Acad Dermatol. 2018;79(5):960-961. https://doi.org/10.1016/j.jaad.2018.05.006.

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