When is synchronous telehealth acceptable for pediatric dermatology?

Abstract

Background/Objectives We evaluated the acceptance of synchronous (live video) telehealth for pediatric dermatology. Methods This was a prospective, single‐center study of patient and dermatologist surveys paired at the encounter level for telehealth encounters with Children's Hospital Colorado Pediatric Dermatology Clinic between 21 April 2020 and 22 May 2020. Results Dermatologists were most receptive to a telehealth encounter for isotretinoin monitoring (96.6%) and non‐isotretinoin acne (89.5%). In contrast, 71.8% and 58.8% of patients surveyed were open to telehealth for isotretinoin encounters and non‐isotretinoin acne encounters, respectively. There was no significant correlation between patient and dermatologist satisfaction regarding a telehealth encounter (r = 0.09, CI [−0.09, 0.26], p = .34) or between patient and dermatologist preference for telehealth encounter (r = 0.07, CI [−0.11, 0.25] p = .46). Dermatologists reported needing a photo to aid their physical examination in 38/363 (10.7%) of encounters and preferred in‐person examinations when an encounter would have benefitted from laboratories, procedures, dermatoscopic examination, examination by palpation, and accurate weights in infants. Conclusions Synchronous, live‐video telehealth is an effective method of healthcare delivery in certain situations for pediatric dermatology, but it does not replace in‐person encounters. Families and dermatologists have different perceptions about its acceptance.

Access to pediatric dermatology

“…Pediatric pigmented lesions are less amenable to synchronous teledermatology due to the need for careful clinical and dermatoscopic evaluation; however, teledermatology can serve as a triage tool with planned, future live evaluation [50]. In one study, among six pediatric dermatologists surveyed, openness to telehealth for new patient visits was low [47 ▪ ].…”

“…Technical difficulties, poor video quality, and desire for live clinical examination are common reasons for dissatisfaction with telehealth among providers. In a recent survey, pediatric dermatologists cited a preference for live visits when laboratory evaluation, procedural management, dermatoscopic examination, lesion palpation, and accurate infant weight (e.g., for propranolol dosing) were required [47 ▪ ]. Differences in utilization of technology, digital literacy, and broadband access among individuals of lower socioeconomic demographics or with LEP pose additional barriers to providing equitable teledermatology care in the pediatric setting [32 ▪ ,51].…”

Retrospective chart review of patient socioeconomic status and language preference associated with live video telehealth in a pediatric dermatology practice

“…A prior publication has characterized our practice during the Telehealth period. 9 In- The Telehealth period includes a small subset of patients who were offered in-person visits at the providers' discretion.…”

Comment on Marasca et al. Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J. Clin. Med. 2022, 11, 1511

“…The remodeling that medicine has rapidly undergone must not be forgotten but used as taught for the advent of possible other pandemics. Finally, telehealth reduces barriers to accessing healthcare for people with disabilities, the elderly population and caregivers needing to find childcare for other children, allowing patients to have a specialist evaluation comfortably in their own homes [ 8 ]. We agree with the analysis carried out by Marasca et al Telemedicine is a precious tool that will find application in future clinical practice, fully integrating with face-to-face medicine.…”