Teledermatology in Rural, Underserved, and Isolated Environments: A Review

Abstract

Purpose of Review Summarize the current evidence for teledermatology in rural, underserved, and isolated environments including its use during the current COVID-19 pandemic. Recent Findings Teledermatology is a reliable and cost-effective tool that can reduce face-to-face visits and improve the timeliness of care for medically underserved populations. Recent studies have shown many additional benefits of teledermatology, including improving patients’ health outcomes and increasing local providers’ knowledge of dermatologic conditions. Despite these benefits, many low-income and rural populations lack access to digital technology and high-speed internet, limiting the reach of telemedical services. Summary Overall, barriers in access to care are unique across the globe, and thus teledermatology interventions should address and adapt to the needs of the local patient population. Certain strategies, such as implementing simple, SF models, using standardized TD consult templets, and providing real-time information technology support could potentially mitigate disparities and improve the effectiveness of TD programs in underserved areas.

The impact of climate change on skin health

“…Teledermatology has been shown to be an effective method of providing dermatological care with the additional benefits of training local practitioners in management of dermatological disease and reducing the carbon footprint associated with patient and clinician travel. 25 In addition, teledermatology services provide the social, cultural and economic benefits of allowing patients to remain on country.…”

“…Teledermatology provides the opportunity to address chronic shortages of dermatology services, particularly in rural and remote areas, which are priority areas likely to be increasingly affected by the health impacts of climate change. Teledermatology has been shown to be an effective method of providing dermatological care with the additional benefits of training local practitioners in management of dermatological disease and reducing the carbon footprint associated with patient and clinician travel 25 . In addition, teledermatology services provide the social, cultural and economic benefits of allowing patients to remain on country.…”

A rural dermatology outreach service – a new model

“…However, this review of 54 articles also appreciates that there are barriers to relying solely on TD for rural provision of dermatology services, including ethical and legal issues, integration of electronic medical records, alleviation of patient concerns over video consultations and the "dehumanisation" of empathetic face-to-face consultations (Coustasse et al, 2019). Furthermore, whilst TD can provide high-quality advice from consultant dermatologists, if there is a lack of resources that inhibits these recommendations being acted on, then the population remains underserved (Ahuja et al, 2022). Further, it can be seen from the available literature that for TD to be successful there are requirements of high-quality Internet connection to enable remote video consultations for "real-time teledermatology" and high-quality images to enable "store and forward teledermatology" (Snoswell et al, 2016).…”

“…As the population ages, the need for dermatology services increases (Bianchi et al, 2020). It has been shown that rural populations have a higher mortality from melanoma and non-melanoma skin cancers (Ahuja et al, 2022), whilst Stitzenberg et al (2007) found that melanoma Breslow depth increased by 0.6% for each mile away from the diagnosing dermatologist. Thus, there is a demand for dermatology care, and indeed, there is a need to provide specialist dermatology services, including skin surgery, systemic biologic treatments and phototherapy for this population.…”

“…Background Teledermatology (TD) has been utilised in healthcare since 1995 (Perednia and Brown, 1995) and has been proven to provide high-quality services to rural populations (Coustasse et al, 2019). The two main models of TD were recently described by Ahuja et al in 2022; the first model "real-time TD" being the use of consultant dermatologist interaction with the patients via live video links, with the second "store-and-forward" model allowing asynchronous review of digital images, often sent from primary care to secondary care specialists for review and management (Ahuja et al, 2022). Hybrid models including both formats of TD have risen in popularity, with an acceleration of this seen during the coronavirus disease 2019 (COVID-19) pandemic (NHS England, 2022).…”