Telemedicine and dermatology hospital consultations during the COVID‐19 pandemic: a multi‐centre observational study on resource utilization and conversion to in‐person consultations during the COVID‐19 pandemic

Trinidad, John; Gabel, Colleen K.; Bonomo, L; Cartron, Alexander M; Chand, Sidharth; Coburn, William; Daveluy, Steven; Davis, Mark D.P.; DeNiro, Katherine L.; Guggina, Lauren; Han, Jaehee; Hennessy, Kerry; Hoffman, Melissa; Katz, Kimberly; Keller, Jacob B.; Kim, Soo Jung; Konda, Sasank; Lake, Eden; Lincoln, Flossy N; Lo, Jennifer A.; Markova, Alina; Marvin, Elizabeth K.; Micheletti, Robert G.; Newman, Sabrina; Nutan, Fnu; Nguyen, Cuong; Pahalyants, Vartan; Patel, Jay; Rahnama‐Moghadam, Sahand; Rambhatla, Pranita V.; Riegert, Maureen; Reingold, Rachel; Robinson, Danielle B; Rrapi, Renajd; Sartori‐Valinotti, Julio C.; Seminario‐Vidal, Lucia; Sharif-Sidi, Zakariyah; Smogorzewski, Jan; Spaccarelli, Natalie; Stewart, Jacob R.; Tuttle, Scott D; Ulrich, Marisa N.; Wanat, Karolyn A.; Xia, Fan; Kaffenberger, Benjamin H.; Kroshinsky, Daniela

doi:10.1111/jdv.17898

Cited by 4 publications

(3 citation statements)

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“…Previous studies suggested that diagnoses could be moderately to substantially concordant even when image reviewers had lower comfort with decision-making. 10,11 Evaluator agreement has the potential to be higher during in-person appointments; one study observed that the diagnostic agreement between 2 dermatologists evaluating patients in person was substantially higher than the agreement between the same dermatologists who reviewed patient images remotely (88% vs 68%). 12 Previous research found that increased messages and images from patients were correlated with higher burnout scores for clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this relatively low concordance, there was substantially higher agreement among image evaluators on diagnosis of a depicted skin condition; dermatologists felt more comfortable providing a diagnostic categorization rather than decision-making based on the images (86.6% vs 55.1% of responses). Previous studies suggested that diagnoses could be moderately to substantially concordant even when image reviewers had lower comfort with decision-making . Evaluator agreement has the potential to be higher during in-person appointments; one study observed that the diagnostic agreement between 2 dermatologists evaluating patients in person was substantially higher than the agreement between the same dermatologists who reviewed patient images remotely (88% vs 68%) …”

Section: Discussionmentioning

confidence: 99%

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Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images

et al. 2022

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ImportancePatient-submitted images vary considerably in quality and usefulness. Studies that characterize patient-submitted images in a real-life setting are lacking.ObjectiveTo evaluate the quality and perceived usefulness of patient-submitted images as determined by dermatologists and characterize agreement of their responses.Design, Setting, and ParticipantsThis survey study included patient images submitted to the Department of Dermatology at Duke University (Durham, North Carolina) between August 1, 2018, and December 31, 2019. From a total pool of 1200 images, 10 dermatologists evaluated 200 or 400 images each, with every image being evaluated by 3 dermatologists. Data analysis occurred during the year leading up to the article being written.Main Outcomes and MeasuresThe primary outcomes were the responses to 2 questions and were analyzed using frequency counts and interrater agreement (Fleiss κ) to assess image quality and perceived usefulness. We performed a random-effects logistic regression model to investigate factors associated with evaluators’ decision-making comfort. We hypothesized that most images would be of low quality and perceived usefulness, and that interrater agreement would be poor.ResultsA total of 259 of 2915 patient-submitted images (8.9%) did not depict a skin condition at all. The final analysis comprised 3600 unique image evaluations. Dermatologist evaluators indicated that 1985 images (55.1%) were useful for medical decision-making and 2239 (62.2%) were of sufficient quality. Interrater agreement for a given image’s diagnostic categorization was fair to substantial (κ range, 0.36-0.64), while agreement on image quality (κ range, 0.35-0.47) and perceived usefulness (κ range, 0.29-0.38) were fair to moderate. Senior faculty had higher odds of feeling comfortable with medical decision-making than junior faculty (odds ratio [OR], 3.68; 95% CI, 2.9-4.66; P &lt; .001) and residents (OR, 5.55; 95% CI, 4.38-7.04; P &lt; .001). Images depicting wounds (OR, 1.75; 95% CI, 1.18-2.58; P = .01) compared with inflammatory skin conditions and that were in focus (OR, 5.56; 95% CI, 4.63-6.67; P &lt; .001) had higher odds of being considered useful for decision-making.Conclusions and RelevanceIn this survey study including 10 dermatologists, a slight majority of patient-submitted images were judged to be of adequate quality and perceived usefulness. Fair agreement between dermatologists was found regarding image quality and perceived usefulness, suggesting that store-and-forward teledermatology initiatives should consider a physician’s individual experiences and comfort level. The study results suggest that images are most likely to be useful when they are in focus and reviewed by experienced attending physicians for wound surveillance, but dermatologists may be burdened by irrelevant or unsuitable images.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images

et al. 2022

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“…Moreover, telemedicine was utilized more among individuals with AD, possibly due to the accessibility of diagnostic tools for dermatologic diagnoses, such as high-quality photographs. 4 According to Trinidad et al, 4 telemedicine became an invaluable tool for dermatology hospitalists during the COVID-19 pandemic, as many physicians were able to comfortably diagnose patients with cutaneous diseases without an in-person visit. Utilizing telemedicine for patient care can help reduce the risk for COVID-19 transmission while also providing quality care for individuals living in rural areas.…”

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Impact of the COVID-19 Pandemic on Care for Patients With Atopic Dermatitis

Smith

2023

Cutis

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AD) is a widely prevalent dermatologic condition that can severely impact a patient's quality of life. 1 Individuals with AD have been substantially affected during the COVID-19 pandemic due to the increased use of irritants, decreased access to care, and rise in psychological stress. 1,2 These factors have resulted in lower quality of life and worsening dermatologic symptoms for many AD patients over the last few years. 1 One major potential contributory component of these findings is decreased accessibility to in-office care during the pandemic, with a shift to telemedicine instead. Accessibility to care during the COVID-19 pandemic for AD patients compared to those without AD remains unknown. Therefore, we explored the impact of the COVID-19 pandemic on care for patients with AD in a large US population.Using anonymous survey data from the 2021 National Health Interview Survey, 3 we conducted a populationbased, cross-sectional study to evaluate access to care during the COVID-19 pandemic for patients with AD compared to those without AD. We assigned the following 3 survey questions as outcome variables to assess access to care: delayed medical care due to COVID-19 pandemic (yes/no), did not get care due to COVID-19 pandemic (yes/no), and virtual medical appointment in the last 12 months (yes/no). In Table 1, numerous categorical survey variables, including sex, health insurance status, race/ ethnicity, education, US citizenship, birth in the United States, public assistance/welfare, and region, were analyzed using χ 2 testing to evaluate for differences among individuals with and without AD. Multivariable logistic regression models evaluating the relationship between AD and access to care were constructed using Stata/ MP 17 (StataCorp LLC). In our analysis we controlled for age, sex, health insurance status, race/ethnicity, education,

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Telemedicine as a counselling tool for nurses in Central Africa

Rodríguez‐Ortega,

Ortega‐Latorre,

Montano‐Navarro

et al. 2024

Journal of Advanced Nursing

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AimCompare the use and trend of a telemedicine tool for clinical advice among nurses and other Cameroonian healthcare providers and explore its feasibility and accessibility.DesignA comparative observational descriptive study.MethodsThe sample includes all telemedicine users who request advice from volunteer medical specialists in Spain on clinical cases through the telemedicine tool “diagnosis assistance” (DA). It consisted of a total of 296 Cameroonian health professionals (59% women), of whom 77 were nurses. The variables in which the trend was explored (2013–2022) were DAs entered by nurses versus other healthcare professionals, compared by primary specialty, comments and documents attached. Feasibility and accessibility were explored through an anonymous survey.ResultsThere were 2527 DAs between 2013 and 2022, of which nurses introduced 68%. There is an increasing trend in the nurse/other healthcare providers ratio, with significant differences in the chi‐square of the linear trend between 2015 and 2022 (χ2 = 395.05; df = 7; p < .001). The probability that a DA was requested by nurses (PR >1) was observed in all years except for 2014, 2018 and 2019. The most tele‐counselling requested by nurses was in the specialties of internal medicine, obstetrics and gynaecology, and dermatology. The exchange of comments and attachments was mainly conducted among nurses (74.9% and 50.4%, respectively). The users surveyed considered the tool valuable for diagnosis, applicable, with limitations due to cost, Internet quality or lack of time and effective at reducing hospital referrals.ConclusionsTelemedicine for clinical advice has been used mostly and with increasing tendency by nurses, mainly in internal medicine, gynaecology and dermatology, being a useful and feasible resource that can contribute to improving clinical decision‐making by African nurses.ImpactThe study addressed the problem of the shortage of health professionals in Central Africa and the search for alternatives that facilitate decision‐making in this context. Tele‐counselling tools through digital platforms that put Spanish specialists in contact with health professionals in Central Africa are mostly used by nurses working in rural health centres with a growing trend in their use. The research allows us to determine that tele‐counselling tools constitute a well‐accepted resource, which has a positive impact in environments with a shortage of human health resources, favouring the safety of both the nursing professional, through support in decision‐making, and the populations to whom they provide care, who benefit from a multidisciplinary approach to their processes.Reporting MethodThe study has adhered to STROBE guidelines.Patient or Public ContributionNo Patient or Public Contribution.

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Telemedicine and dermatology hospital consultations during the COVID‐19 pandemic: a multi‐centre observational study on resource utilization and conversion to in‐person consultations during the COVID‐19 pandemic

Cited by 4 publications

References 9 publications

Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images

Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images

Impact of the COVID-19 Pandemic on Care for Patients With Atopic Dermatitis

Telemedicine as a counselling tool for nurses in Central Africa

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