Evaluation of a telehealth clinic as a means to facilitate dermatologic consultation: pilot project to assess the efficiency and experience of teledermatology used in a primary care network.
BACKGROUND
Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention.


OBJECTIVE
To determine if telehealth combined with interdisciplinary team-based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians.


METHODS
Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured.


RESULTS
Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations.


CONCLUSIONS
Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.
Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada. dave_ludwick@shaw.ca
David A
DA
Ludwick
Charles
C
Lortie
John
J
Doucette
Jaggi
J
Rao
Christine
C
Samoil-Schelstraete
D000416:Alberta; D003880:Dermatology / Q000379:methods*; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care; D019114:Remote Consultation; D012189:Retrospective Studies; D014850:Waiting Lists