title: Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective.
abstract: BACKGROUND
  Teledermatology has been used to provide increased specialty access for medically underserved communities. In California, policies enable the California Medicaid (Medi-Cal) program to provide reimbursement for both store-and-forward (S&F) and live-interactive teledermatology consultations. To assess the effectiveness of teledermatology operations for this population, understanding the referring providers' perspective is crucial. The primary objective of this study was to explore the perspective of referring primary care providers (PCPs) on teledermatology by focusing on the operational considerations, challenges, and benefits to participating in teledermatology referral in the context of the Medi-Cal population.
  
  
  METHODS
  We conducted hour-long one-on-one interviews with 10 PCPs who refer patients to teledermatology regularly and who together serve an average aggregate referral base of 2,760 teledermatology cases yearly.
  
  
  RESULTS
  Of the 2,760 aggregate annual teledermatology referrals, PCPs reported that they serve predominantly uninsured or underinsured populations and participate in S&F consultations. The majority of surveyed PCPs treat common skin conditions themselves. However, these PCPs refer more patients to teledermatology consultations than in-person dermatology encounters. Several factors influence PCPs' decision to refer to teledermatology, which include complexity of the skin problem, distance to accessible dermatologist, patient's insurance, and patient's preferences. PCPs identified improved workflow, enhanced communication with dermatologists, and faster turnaround for recommendations as three areas that referring physicians would like improved in their experience with teledermatology.
  
  
  CONCLUSIONS
  Understanding the referring provider's perspective and subsequently adopting policy and practice solutions to address their challenges are vital to prompting further teledermatology participation for underserved communities.
authors.affiliation: Department of Dermatology, University of California at Davis School of Medicine, Sacramento, California 95816, USA. aprilarmstrong@post.harvard.edu
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Mei W
authors.initials: MW
authors.lastname: Kwong
authors.forename: Elizabeth P
authors.initials: EP
authors.lastname: Chase
authors.forename: Lynda
authors.initials: L
authors.lastname: Ledo
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Nesbitt
authors.forename: Sandra Louise
authors.initials: SL
authors.lastname: Shewry
mesh_terms: D001291:Attitude of Health Personnel; D002140:California; D003625:Data Collection; D003880:Dermatology / Q000379:methods* / Q000458:organization & administration; D020375:Education, Distance / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D016134:Organizational Policy; D058007:Physicians, Primary Care / Q000523:psychology*; D012017:Referral and Consultation; D017216:Telemedicine / Q000379:methods* / Q000458:organization & administration; D014481:United States