title: Asynchronous teledermatology in an urban primary care practice.
abstract: This study evaluated the accuracy, access time, cost, and acceptance by patients and physicians of asynchronous teledermatology referrals in an urban primary care practice. Primary care physicians in a multi-specialty group referred patients for a teledermatology consult. Same-day history and digital images taken by a nurse were electronically sent to a dermatologist who rendered a diagnosis to the physician. Fifty-two patients completed the study. History was adequate for diagnosis in 81% of cases; images were adequate in 75% of cases. Accuracy of the teledermatology diagnosis in cases with adequate images was 97%; accuracy for all cases was 92%. A dermatology visit was recommended in 26% of cases with adequate images, and 42% of all cases. Access time for a teledermatology opinion was 1.9 days versus 52 days for a regular dermatology appointment. Patient and referring physician were highly in favor of teledermatology. Cost evaluations for 20% of patients suggested the cost of a remote consult to be significantly less than the cost of performing an in-person referral. Asynchronous teledermatology may serve as a valuable tool for triage of dermatology referrals and possibly for delivering care to more patients than in urban areas. It can decrease waiting time for a dermatology diagnosis. In an urban multi-specialty clinic-based primary care practice, results suggest the cost of a teledermatology consult is less than that of an in-person service.
authors.affiliation: Department of Dermatology, Lahey Clinic Medical Center, Dover, Massachusetts 02030, USA. thrlmcky@massmed.org
authors.forename: Karen C
authors.initials: KC
authors.lastname: McKoy
authors.forename: Sharon
authors.initials: S
authors.lastname: DiGregorio
authors.forename: Lisa
authors.initials: L
authors.lastname: Stira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003880:Dermatology / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care; D012871:Skin Diseases / Q000175:diagnosis; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics; D014505:Urban Population