Telemedicine boosting dermatology care

A study of nearly 1,500 patients who had teledermatology consultations shows improved clinical outcomes, with better diagnosis and disease management.

By — Posted Jan. 31, 2012

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Linking dermatologists to patients in remote areas through telemedicine gives patients more accurate diagnoses and better disease management than they would receive without access to a specialist, says a study in the January Archives of Dermatology.

Researchers analyzed data from 1,490 patients who had teledermatology consultations and found that patients received a diagnosis that was different from the referring physician's in 70% of cases. In 98% of cases, dermatologists recommended changes in the way patients were managing their condition.

"We were more surprised that a lot of these changes in management did lead to an improvement in their disease," said study co-author April W. Armstrong, MD, MPH, director of teledermatology at the University of California Davis School of Medicine. "The changes in management and the changes in diagnosis really correlated with patients' improvement."

Improved clinical outcomes were seen for 69% of 313 patients who had at least one follow-up visit within a year, the study said. Patients who had their diagnosis changed in the initial consultation were about two times more likely to show clinical improvement in future visits compared with patients whose diagnosis did not change (link).

Patients in the study ranged from 3 months to 88 years old. They all had a live, interactive telemedicine visit with a dermatologist at UC Davis between 2003 and 2005.

Researchers hope the study will help educate dermatologists, family physicians and other primary care professionals about how telemedicine can benefit their patients, said Dr. Armstrong, who directs the university's dermatology clinical research unit. Telemedicine is used increasingly to connect dermatologists and other specialists with patients in remote, medically underserved areas.

"This information will appeal to a lot of primary care physicians, especially those who feel that they can't get a patient to see a dermatologist in a timely manner," she said.

About 40 dermatology programs in the U.S. use telemedicine. The most common form of teledermatology is known as "store and forward," in which details about the patient are recorded and sent to a specialist to review later. Live teledermatology requires more schedule coordination, but it provides real-time interaction between patients and physicians, the study said.

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Dermatology from a distance

A study of nearly 1,500 patients who had teledermatology consultations at the University of California Davis School of Medicine from 2003 to 2005 found that most patients benefited from a new diagnosis and altered recommendations for disease management.

Variable Percent of cases
Diagnosis change 70%
No change in diagnosis 30%
Overall change in disease management 98%
Change in medication dosage 5%
Stop or start medication 68%
Request for more lab work 18%
Intervention such as biopsy 26%

Source: "Impact of Live Interactive Teledermatology on Diagnosis, Disease Management and Clinical Outcomes," Archives of Dermatology, January (link)

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