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Live Interactive Teledermatology for Skin Disease Diagnosis, Management and Clinical Outcomes

As technology changes the way we live, communicate and attain information, it may also change the way doctors diagnose and treat their patients.  Telemedicine is medical care delivered through technological means, such as through live chat or image download. 

 

For patients living in medically under-served or distant communities, telemedicine may mean increasing opportunity for treatment.  This form of health care delivery is especially practical for the diagnosis and management of skin diseases as many of these issues can be understood through video and still images. 

 

A study was conducted to asses the impact of live interactive teledermatology treatment on changes in skin disease diagnosis, management and clinical outcome.

 

Two Forms of Teledermatology

 

1. Store-and-Forward (S&F)

+ Is popular in use

+ Does not allow for instant clarification on patient history

+ Does not require technology for live chat, often hard to come by in developing or under-served areas

 

2. Live Interactive (LI)

+ Enables live dialogue between patient and specialist

+ Allows for real-time question-asking and clinical history education

+ Requires video-conferencing equipment and Internet connection

 

The Skinny on the Study Methods

The impact of live interactive (LI) teledermatology on skin disease diagonsis, management and clinical outcome was studied through information gathered from the University of California, Davis Center for Health and Technology database.

 

  • 313 patients were included for having had 2 or more LI teledermatology visits in a one year period
    • Patients ranged from 3 months to 88 years old
    • 75.5% male, 24.5% female
  • Dermatologists worked typically in 4 hour blocks, treating patients via video-conference in a sequential manner
  • Research team reviewed patients’ files to determine if there was a change in diagnosis, disease management or improvement post teledermatology consultation.  
    • Change in diagnosis was defined by comparing the diagnosis of the LI consultant dermatologist with the referring dermatologist  
    • Change in disease management was defined by comparing the treatment plan of the LI consultant and referring dermatologist including changes in dosage or vehicle of medicine, recommended biopsy, phototherapy or laser treatment
    • Change in clinical outcome was determined by two dermatologists independantly reviewing each patient’s first teledermatology visit with their last teledermatology visit in the same year.  “Improvement” was recorded when clinical improvement was evident in the comparison of the two visits.  “No Improvement” marked no change or a worsening in the patient’s condition between the first and last visit.

 

Study Results

  • Change in diagnosis from referring primary care provider (PCP) to teledermatologist (TD): 69.9%
    • Top 3 changes: (1) PCP diagnoses skin infection where TD diagnoses primary inflammatory process (eczema looking like fungal infection), (2) PCP diagnoses malignant lesion where TC diagnoses benign lesions (seborrheic keratosis looking like melanoma), (3) PCP diagnoses benign lesions where TC diagnoses malignancy (basal cell carcinoma looking like benign dermal nevus)
  • Change in disease management were shown in 97.7% of patient consultations
    • Management was broken down into initiation or discontinuation of medication (67.5% of cases), change in dosage or vehicle of a medication (4.8% of cases), addition of lab tests or cultures (18.3% of cases).  Various procedural changes such as biopsy, excursion or phototherapy recommended in 26.4% of TD consults.
  • Change in clinical outcome showed improvement for 68.7% of LI teledermatology consulted patients.  The number of visits and change in disease diagnosis and management was associated with the improvement. 

 

 

Conclusions

Reported to be the largest study to date on clinical outcomes of LI teledermatology, this study found that 70% of analyzed patients experienced change in diagnosis and more than 97% saw change in the disease management after their teledermatology consultation.  Both of these numbers are significantly associated with positive changes for patients’ clinical outcomes.  As technological advancements improve LI teledermatology, it is reported that these video consultations will become more efficient and close to a live patient-to-doctor experience.  Continued research on effectiveness and positive clinical outcomes is needed to ensure teledermatology is delivering quality care.

 

[Image by Patrick Hoesly]

Source: Archives of Dermatology, Vol. 148 No 1, January 2012




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