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Lessons learned in teledermatology

Research conducted at the Beth Israel Deaconess Medical Center in Boston, Mass. suggests teledermatology consultations are best suited for acne and non-specific dermatitis. Additionally, researchers concluded that the evaluation of lesions may be best suited for in-person visits with a dermatologist.

Led by Dr. Jean S. McGee, a dermatologist at the Beth Israel Deaconess Medical Center’s Department of Dermatology, the study ‘Fighting COVID-19: Early Teledermatology Lessons Learned’ found that longer teledermatology consultations were more likely to be conducted by telephone, rather than video. This finding raises the possibility that visual cues may be an important consideration in teledermatology visits.

The study was published online ahead of print in the Journal of the American Academy of Dermatology (June 15, 2020).

“Moving forward, we are tasked with creating a new practice model that is likely to be a hybrid of both in-person and teledermatology,” the authors wrote in the study. “Our early data supports allocating teledermatology resources for certain diagnoses including acne and rashes. However, we need further studies to understand the operational and financial implications of having extra teledermatology visits for the evaluation of lesions.”

In response to the Covid-19 pandemic, dermatology practices introduced teledermatology services to continue care. Researchers at the Beth Israel Deaconess Medical Center randomly selected 274 teledermatology visits conducted in April 2020 in the department of dermatology at Beth Israel Deaconess Medical Center to evaluate early practice patterns to identify variations in the quality of and access to teledermatology services.

According to the researchers, prior to the pandemic, 32% of patients seen in person were older than 65 years and 7% of patients seen in person were non-English speaking, those defined as necessitating interpreter service. During the pandemic, 23% of patients seen in teledermatology were older than 65 years and 3% of patients seen in teledermatology were non-English speaking.

The study’s authors found the two most common diagnoses seen in teledermatology, other than a lesion of concern, were acne (52%) and dermatitis (49%). Nearly all teledermatology visits with these diagnoses led to a recommendation for either discharge or follow-up via subsequent teledermatology visits.

Teledermatology visits for the evaluation of lesions led to a recommendation to follow up in person for revaluation or biopsy in 60% of the cases evaluated. The researchers also found 75% of teledermatology visits with durations of 20 minutes or greater were conducted via telephone, rather than a video-based platform.

“Our study suggests that elderly patients and non-English speaking patients may be experiencing unequal access to teledermatology care during the pandemic,” the authors concluded. “Limited proficiency with technology, administrative burden to mobilize an interpreter service, and hesitancy on the part of patients to receive medical care via virtual platforms can all contribute to these findings.”

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