Conference Coverage

Teledermatology can increase efficiency



In addition to improving patient access, teledermatology can increase the efficiency of dermatology services, according to a retrospective study presented at the annual meeting of the American Academy of Dermatology

Investigators previously have found that teledermatology systems, used by dermatologists to triage and manage patients, do improve patient access. Analyses of the clinical efficiency of these systems have demonstrated mixed results, however, and few such studies have been conducted in large, closed health care settings such as VA and county hospitals.

To investigate these open questions, Adam Zakaria, a third-year medical student at the University of California, San Francisco, and colleagues created a direct efficiency measure to analyze the teledermatology system at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG), which was established in January 2015. ZSFG is a public safety net hospital that serves approximately 150,000 patients annually, according to Mr. Zakaria.

Before the teledermatology system was implemented, each patient seeking to consult a ZSFG dermatologist needed a referral from a primary care provider. Appointments were given on a first-come, first-served basis, “with little consideration for the acuity or the severity of the patient’s complaint,” Mr. Zakaria said at the meeting. Since the teledermatology system has been put in place, referring providers have submitted brief clinical histories and relevant photographs to the system. Once per week, a UCSF dermatology provider and three to four UCSF dermatology residents meet to review cases and decide whether patients can be treated by their primary care providers with recommendations from teledermatology, or whether they need to be seen in person at the dermatology clinic for further evaluation.

The investigators compared data for two patient cohorts: Patients scheduled for in-person clinic visits between June 2014 and December 2014 (the preteledermatology sample), and the second cohort, patients who were triaged through the teledermatology system between June 2017 and December 2017 and who only received a clinic appointment if they could not be managed by their referring provider with teledermatology recommendations (the postteledermatology sample). Data came from chart review, administrative record review, and records from the specialty care and diagnostics department at ZSFG.

Patient wait times for the live clinic and total patient cases handled per month were chosen as measures of accessibility. The measures of efficiency were the number of cases handled per dermatologist hour and the percentage of referrals managed without a live visit. Mr. Zakaria and colleagues performed two-tailed t-tests for each measure.

The analysis included 11,586 patients. Approximately 50% of the sample identified as nonwhite, approximately one-third of patients had a native language other than English, and more than three-quarters of patients had a form of public health insurance.

After the hospital implemented teledermatology, patient wait times decreased significantly (84.6 days vs. 6.7 days; P less than .001), total cases handled per month increased significantly (754 vs. 902; P = .008). In the postteledermatology period, 61.8% of teledermatology consults were handled without a live visit.

After the implementation of teledermatology, the number of cases handled per dermatologist hour increased from 2.27 to 2.63, which was statistically significant (P = .01). The total time that dermatologists spent reviewing teledermatology cases or seeing patients in the live dermatology clinic increased from 332 hours per month to 342 hours per month, an increase that was not statistically significant, however. When the researchers compared provider hours and resident hours, they again found no statistically significant difference.

The results indicate that “the benefits of teledermatology did carry over when applied in a large, closed health care setting,” said Mr. Zakaria. “Two future areas of investigation include evaluating the impact of teledermatology on the quality of resident education and assessing the costs and benefits that teledermatology imposes upon referring primary care providers.” Mr. Zakaria and his colleagues also are analyzing the costs of teledermatology.

SOURCE: Zakaria A et al. AAD 19, Abstract 10087.

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