Telemedicine dermatology consultations change diagnoses and improve outcomes
Research Activities, September 2012, No. 385
Telemedicine services continue to mature as a way to provide patient care from a distance, especially for rural areas. Dermatology lends itself well to telemedicine, since skin conditions can be visibly seen on a screen. Recently, researchers compared teledermatology consults at a large academic medical center with diagnoses and treatment made initially by the referring physician. In the majority of instances, the telemedicine consultations resulted in changes in diagnosis and disease management. The study included 1,490 patients who received a teledermatology consultation from a large academic dermatology clinic. Of these, 313 had 2 or more telemedicine visits. All were referred by primary care providers from 31 facilities across California. Research assistants reviewed each patient's medical record to see if the teledermatology consultation resulted in a change in diagnosis, disease management, and clinical outcome.
A teledermatology consultation resulted in a change in diagnosis in 69.9 percent of cases. The top change was from a diagnosis of skin infection to diagnosis of a primary inflammatory process. Other leading changes involved an incorrect primary care diagnosis of either a benign or malignant lesion. These telemedicine consultations also led either to the start of or discontinuation of therapy in 67.5 percent of cases. More than a quarter of cases (26.4 percent) resulted in various surgical and other treatment interventions. Overall 97.7 percent of consultations resulted in changes in disease management. In the group of 313 patients with two or more consultations, 215 of them (68.7 percent) experienced an improvement in clinical status after their teledermatology encounter. Those patients with a change in diagnosis had nearly two times greater odds of clinical improvement compared to those with no change. After the first consultation, each additional followup telemedicine visit was associated with double the odds of improvement in clinical outcomes.
The study was supported in part by the Agency for Healthcare Research and Quality (HS18341).
See "Impact of live interactive teledermatology on diagnosis, disease management, and clinical outcomes," by Sonia Lamel, M.D., Cindy J. Chambers, M.D., M.P.H., Mondhipa Ratnarathorn, M.D., and April W. Armstrong, M.D., M.P.H., in the January 2012 Archives of Dermatology 148(1), pp. 61-65.