Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial

Abstract

Background: Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes. Introduction: We performed a 12-month randomized controlled trial to evaluate the impact of an online, collaborative connected health (CCH) model for psoriasis management on access to specialty care. Materials and Methods: The 300 enrolled patients were randomized to online or in-person care. We compared distance traveled as well as transportation and in-office waiting time between the two groups and obtained patient and provider perspectives on CCH. Results: At baseline, no differences existed between the groups in difficulties obtaining specialty care. Over 12 months, the mean (standard deviation [SD]) distance traveled to and from appointments was 174.8 (±577.4) km/person for the in-person group and 2.2 (±14.2) km/person for the online group (p = 0.0003). The mean (SD) time spent on transportation and in-office waiting for in-person appointments was 4.0 (±4.5) h/person for the in-person group and 0.1 (±0.4) h/person for the online group (p = 0.

A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation

“…Questionnaires (20 studies, 67% of included studies) and interviews (9 studies, 30% of included studies) were the most common methods of data collection. Only three of the thirty studies used a theoretical implementation framework to guide their investigation [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Each of the three studies used the technology acceptance model, a model designed to assess individuals' level of acceptance of technology (i.e., teledermatology).…”

“…Teledermatology technologies were reported to be useful ways to improve both patients' and primary care providers' knowledge and management of skin disorders [3,36,39,41,52,60]. Technology user friendliness was also reported to facilitate teledermatology implementation in some studies [37,41,42,44,56,57,59,60].…”

“…There were three major barriers identified within this domain. First, teledermatology consultation was not able to meet some patients' needs, particularly for certain skin conditions (e.g., allergic disorders) and management procedures (e.g., corticosteroid injection) [43,44,54,60]. Also, patients who did not want to be photographed were unable to pursue store-and-forward teledermatology consultation [41,45,46].…”

“…Factors in the inner setting domain were reported as facilitators to teledermatology implementation in 6 studies. A common theme across these studies was that teledermatology was viewed as compatible with existing workflow and clinical needs [36,41,44,55,60]. Three studies additionally reported that the availability of training [48,60], personnel, and infrastructure support [42] were facilitators to teledermatology implementation.…”

Outcome Measurements Used in Randomized Controlled Trials of Teledermatology: A Systematic Mapping Review

“…Another study, which involved isotretinoin therapy for participants, collected reports of adverse reactions from clinicians during face-to-face or online consultations, depending on which experimental group the participant was allocated into (17). Two other studies mentioned safety only as part of the discussion of their results (18,19).…”