Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers

Background The clinical outcome of teledermatology with dermoscopy in large‐scale primary care networks remains unclear. Objective We evaluate the impact of implementing a teledermatology consultation program with dermoscopy on a statewide scale, focusing on access to care and skin cancer screening for medically underserved populations. Methods Descriptive retrospective cohort study of 2385 dermatology referrals from primary care from June 2014 through November 2015. Results Before implementation of electronic consultations (eConsults), access to dermatology was limited; only 139 (11%) of 1258 referrals resulted in a confirmed appointment with a median wait time of 77 days. Post implementation, 499 of 1127 consults (44%) were sent electronically, and of those, 16% required a face‐to‐face visit with a median wait time of 28 days. Ten malignancies were identified via eConsults. Overall consult volume remained stable pre‐ and post‐eConsult implementation. Limitations We evaluated eConsults in medically underserved populations seeking care at community health centers. Results might not be generalizable to other populations or in other settings. Conclusion eConsults increase access to dermatologic care and reduce wait times for patients receiving medical care at community health centers. Implementing dermoscopy into teledermatology could increase access to skin cancer screening and treatment for medically disadvantaged populations.

[1]  L. Hynan,et al.  Creation of an Internal Teledermatology Store-and-Forward System in an Existing Electronic Health Record: A Pilot Study in a Safety-Net Public Health and Hospital System , 2017, JAMA dermatology.

[2]  D. Moreno-Ramírez,et al.  Store-and-forward teledermatology in skin cancer triage: experience and evaluation of 2009 teleconsultations. , 2007, Archives of dermatology.

[3]  J. Resneck,et al.  Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times. , 2004, Journal of the American Academy of Dermatology.

[4]  Marie-Louise T. Johnson.  Defining the burden of skin disease in the United States--a historical perspective. , 2004, The journal of investigative dermatology. Symposium proceedings.

[5]  M. Cockburn,et al.  Teledermatology as a tool to improve access to care for medically underserved populations: A retrospective descriptive study. , 2016, Journal of the American Academy of Dermatology.

[6]  M. Zirwas,et al.  Disparities in access to dermatologic care according to insurance type. , 2012, Archives of dermatology.

[7]  W. Huang,et al.  Factors associated with missed dermatology appointments. , 2015, Cutis.

[8]  A. Sharafkhaneh,et al.  Prevalence, predictors and economic consequences of no-shows , 2015, BMC Health Services Research.

[9]  W. Branch,et al.  Dermatologic practice: implications for a primary care residency curriculum. , 1983, Journal of medical education.

[10]  C. Nelson,et al.  Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting. , 2016, Journal of the American Academy of Dermatology.

[11]  R A Sheehan-Dare,et al.  An evaluation of the role of a store‐and‐forward teledermatology system in skin cancer diagnosis and management , 2005, Clinical and experimental dermatology.

[12]  J. Kvedar,et al.  Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. , 2015, Journal of the American Academy of Dermatology.

[13]  Martin A Weinstock,et al.  Teledermatology: key factors associated with reducing face-to-face dermatology visits. , 2014, Journal of the American Academy of Dermatology.

[14]  S J Walters,et al.  Telemedicine in dermatology: a randomised controlled trial. , 2006, Health technology assessment.

[15]  N F de Keizer,et al.  Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost , 2011, The British journal of dermatology.

[16]  D. Eedy,et al.  A comparison of real‐time and store‐and‐forward teledermatology: a cost–benefit study , 2000, The British journal of dermatology.

[17]  R. Hay,et al.  The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. , 2014, The Journal of investigative dermatology.

[18]  Lane F Burgette,et al.  Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees. , 2016, JAMA dermatology.

[19]  J. Resneck,et al.  The US dermatology workforce: a specialty remains in shortage. , 2008, Journal of the American Academy of Dermatology.

[20]  M.I. Kadurina,et al.  Teledermatology , 2005, Updates in Clinical Dermatology.

[21]  Steven C Grambow,et al.  Teledermatology's impact on time to intervention among referrals to a dermatology consult service. , 2002, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[22]  Patrick R. Cronin,et al.  A multivariate analysis of dermatology missed appointment predictors. , 2013, JAMA dermatology.

[23]  Michael Shapiro,et al.  Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology. , 2004, Archives of dermatology.

[24]  J. Resneck,et al.  Few Medicaid and uninsured patients are accessing dermatologists. , 2006, Journal of the American Academy of Dermatology.

[25]  The impact of store-and-forward teledermatology on skin cancer diagnosis and treatment. , 2008, Journal of the American Academy of Dermatology.

[26]  J. Frey,et al.  A multi-method intervention to reduce no-shows in an urban residency clinic. , 2013, Family medicine.

[27]  Varsha G. Vimalananda,et al.  Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis , 2015, Journal of telemedicine and telecare.