Teledermatology as a tool to improve access to care for medically underserved populations: A retrospective descriptive study

Leavitt, Erica; Kessler, Stephen E.; Pun, Stacey; Gill, Tania; Escobedo, Loraine A.; Cockburn, Myles; Sutton, Adam; Crew, Ashley

doi:10.1016/j.jaad.2016.07.043

Cited by 32 publications

(32 citation statements)

References 5 publications

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“…5 Teledermatology also decreases waiting times and increases efficiency in certain practice settings. [6][7][8][9][10] For example, in the emergency department, compared to care by emergency room (ER) physicians alone, teledermatologists improved the diagnostic workup in almost 70% of cases and enabled more patient discharges from the ER than hospital admissions. 6 In Los Angeles County, 21% of suspected skin malignancies and 29% of suspected melanomas referred from primary care physicians were triaged by teledermatology as nonmalignant and not requiring an in-person consultation.…”

Section: Introductionmentioning

confidence: 99%

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Teledermatology in the United States: An Update in a Dynamic Era

Yim

Florek

et al. 2018

Telemedicine and e-Health

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Section: Introductionmentioning

confidence: 99%

“…6 In Los Angeles County, 21% of suspected skin malignancies and 29% of suspected melanomas referred from primary care physicians were triaged by teledermatology as nonmalignant and not requiring an in-person consultation. 7 Implementation of teledermatology may be essential to meet the heightened demand for dermatologic expertise.…”

Section: Introductionmentioning

confidence: 99%

Teledermatology in the United States: An Update in a Dynamic Era

Yim

Florek

et al. 2018

Telemedicine and e-Health

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“…Pharmacy restrictions act as an additional barrier in underserved populations as evidenced in an urban area in the US [42] and in Belize [67•], as does limited access to labs and an underdeveloped infrastructure, which is often the experience in remote areas [89]. Another barrier, especially for remote areas, is inaccessibility to the Internet and poor connection quality, since mobile devices are being used more readily as a tool to provide access in these areas throughout the world [34,68].…”

Section: Methodsmentioning

confidence: 99%

“…Finally, inadequate follow-up is a barrier to implementation of quality teledermatology [42]. A teledermatology program in 12 countries in sub-Saharan Africa with purposefully limited guidelines and simple record keeping requirements led to wide variability in clinical histories and an inability to track returning patients [33].…”

Section: Methodsmentioning

confidence: 99%

“…Teledermatology was largely introduced for rural Veterans in the VA; however, urban Veterans have now constituted the majority of patients served since 2012 [39 • ]. Teledermatology has also been introduced to increase access to dermatologic care amongst medically underserved urban populations in the US [42] and in resource-poor outpatient settings, with one study finding that at least 61% of referred patients would not have received dermatologic care without teledermatology [43].…”

Section: Reachmentioning

confidence: 99%

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Implementation of Teledermatology: Theory and Practice

et al. 2019

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Purpose of Review Multiple factors influence the success and failure of teledermatology programs. We evaluate the current teledermatology literature using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework developed for implementation research. We introduce this framework to encourage a thorough examination of teledermatology's implementation including its sustainability. In this way, programs can better realize teledermatology's promise for enhancing patients' access to expert dermatologic care in real-world healthcare settings. Recent Findings While teledermatology continues to expand throughout the world, barriers continue to exist. Many evaluations of teledermatology focus on the effectiveness of the programs, without examining other factors that underlie success. The use of implementation science enables researchers to better assess different factors influencing a program's success or failure. Summary Implementation science offers theories, frameworks, and methodologies to study and improve teledermatology's impact.

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Comparison of Dermatologist Density Between Urban and Rural Counties in the United States

et al. 2018

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A n adequate and appropriately trained physician workforce is necessary to meet the nation's current and future health care demands. As the US population continues to increase and age, there is an unmet need for dermatologic care. 1 The increasing incidence of skin cancer, high prevalence of complex inflammatory skin disorders, advanced therapeutics, and widening market for surgical and noninvasive procedures have also contributed to an increased demand for dermatologists that is expected to continue to increase. 1-7 The undersupply of dermatologists has been described during the past 2 decades, 5,8-10 and previous work has identified the maldistribution of physicians and dermatologists. 11-14 Rural areas face significant physician workforce shortages, with rural residents experiencing long wait times and traveling long distances to receive care. 5 This pattern is especially important given previous studies 15-17 that found that dermatologist density is associated with patient outcomes for diseases, such as melanoma and Merkel cell carcinoma. To develop strategies and effective policies to offset a shortage, we must better understand the characteristics and patterns observed in the dermatologist workforce. We hypothesize that despite an expanding dermatologist workforce, there is a widening gap between dermatologists in urban and rural settings given the greater professional opportunities in urban areas, desire for proximity to family and support, and insufficient financial incentives to practice in resource-poor areas. 13,18-22 The goal of this study was to build on existing work by evaluating the up-to-date longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists, using a classification scheme that measures the degree of urbanization in each US county. Methods Demographic and physician data from 1995 to 2013 were obtained from the Area Health Resources File (AHRF). 23 The New IMPORTANCE As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce. OBJECTIVE To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme. DESIGN, SETTING, AND PARTICIPANTS This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists. MAIN OUTCOMES AND MEASURES Active US dermatologist and physician density. RESULTS In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to you...

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Teledermatology as a tool to improve access to care for medically underserved populations: A retrospective descriptive study

Cited by 32 publications

References 5 publications

Teledermatology in the United States: An Update in a Dynamic Era

Teledermatology in the United States: An Update in a Dynamic Era

Implementation of Teledermatology: Theory and Practice

Comparison of Dermatologist Density Between Urban and Rural Counties in the United States

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