Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations

Wang, Robin H; Barbieri, John S.; Kovarik, Carrie L.; Lipoff, Jules B.

doi:10.1177/1357633x221074504

Cited by 23 publications

(16 citation statements)

References 45 publications

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“…1 , 6 , 8 , 27 Current evidence suggests diagnosis and initial management of typical presentations of common rashes (eg, psoriasis, atopic dermatitis, acne, and rosacea) as well as follow-up care, medication monitoring, and prescription refills for established diagnoses can often be resolved during synchronous teledermatology visits. 13 , 28 , 29 In contrast, full-body skin examinations or evaluation of lesions concerning for malignancy may be better suited for in-person appointments, which permit dermoscopy and biopsy procedures. 9 , 13 , 28 , 29 , 30 , 31 Synchronous visits may also create technological difficulties for patients, 6 , 26 which can lower the image quality and contribute to increased time per appointment.…”

Section: Synchronous Live-interactive Visitsmentioning

confidence: 99%

See 1 more Smart Citation

Evolving teledermatology policy and reimbursement landscape in the United States

Lin¹,

Deitermann²,

Miller³

et al. 2023

JAAD International

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Section: Synchronous Live-interactive Visitsmentioning

confidence: 99%

“…1 , 12 Given the prepandemic prominence of store-and-forward modality, we also discuss considerations for asynchronous teledermatology. 9 , 13 While we focus on the policy in the United States, lessons learned are relevant to an international audience.…”

Section: Introductionmentioning

confidence: 99%

Evolving teledermatology policy and reimbursement landscape in the United States

Lin¹,

Deitermann²,

Miller³

et al. 2023

JAAD International

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“…Additionally, appointment wait times are reduced [39]. From a provider standpoint, synchronous visits enable direct physician-patient interaction, more closely mimic in-office visits, and are typically reimbursed by insurance [42 ▪ ,43].…”

Section: Teledermatologymentioning

confidence: 99%

Access to pediatric dermatology

Barry

Hawryluk

2022

Current Opinion in Pediatrics

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Purpose of reviewTo identify factors that impact accessibility to pediatric dermatology and review healthcare delivery models that improve access and address these barriers.Recent findingsUp to one-third of pediatric primary care visits include a skin-related problem, yet pediatric dermatology subspecialist services are highly inaccessible. Workforce shortages and geographic, sociocultural, and economic barriers perpetuate inaccessibility. Teledermatology expands care, particularly to underserved or geographically remote communities, and reduces healthcare-related costs. Federal legislation to support telehealth services with adequate reimbursement for providers with parity between live, video, and phone visits will dictate the continued feasibility of virtual visits. Innovative care delivery models, such as language-based clinics, multidisciplinary teleconferencing, or embedded dermatology services within primary care are other promising alternatives.SummaryDespite efforts to expand access, dermatology still ranks among the most underserved pediatric subspecialties. Improving access requires a multipronged approach. Efforts to expand exposure and mentorship within pediatric dermatology, diversify the workforce and clinical curriculum, recruit and retain clinicians in geographically underserved areas, and collaborate with policymakers to ensure adequate reimbursement for teledermatology services are necessary.

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“…Given the visual nature of dermatologic examinations, delivery of high-quality teledermatology care requires adequate visualization of the patient's skin. It can be difficult to properly visualize the skin through live-interactive video, and photographs are preferred for adequate skin evaluation [17]. Previous evaluations of teledermatology care have not assessed whether patients had submitted photographs for their video or telephone visits, which can be an important determinant of the quality of care received.…”

Section: Introductionmentioning

confidence: 99%

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Lamb¹,

Fitzsimmons²,

Sevagamoorthy³

et al. 2022

JMIR Dermatol

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Background The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient’s skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. Objective The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. Methods We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. Results In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. Conclusions Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care.

show abstract

Synchronous and asynchronous teledermatology: A narrative review of strengths and limitations

Cited by 23 publications

References 45 publications

Evolving teledermatology policy and reimbursement landscape in the United States

Evolving teledermatology policy and reimbursement landscape in the United States

Access to pediatric dermatology

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

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