title: Teledermatology Implementation in a VHA Secondary Treatment Facility Improves Access to Face-to-Face Care.
abstract: BACKGROUND
  Teledermatology is a mainstream modality for delivering care in the Veterans Health Administration, especially in rural areas where access to traditional dermatology care is constrained. Previous investigations of the effect of teledermatology on improving patient access have focused largely on the metrics of visits avoided. However, the effect of teledermatology on improving patient access to face-to-face dermatology has not been well documented. The purpose of this study was to assess the impact of the implementation of store-and-forward teledermatology on access to face-to-face dermatology at the Mann-Grandstaff Spokane Veterans Administration (VA) Medical Center in Spokane, WA.
  
  
  METHODS
  Completed requests for dermatology and teledermatology consultation originating from the Spokane main facility from January 1, 2012 through June 30, 2013 were obtained from the Corporate Data Warehouse by SQL query. The numbers of consult requests and wait times for care for overall dermatology, face-to-face dermatology, and teledermatology were compared across the baseline, transition, and intervention periods.
  
  
  RESULTS
  Within 6 months of implementation, the total number of requests for dermatology services increased by 40%. Access to face-to-face dermatology care improved, with a decrease in the duration of the interval between consultation request and consultation completion from a mean of 64.2 days to 20.3 days; overall access to dermatology (teledermatology and face-to-face dermatology) care improved with a decrease in the duration of the same from a mean of 61.2 days to 10.3 days.
  
  
  CONCLUSIONS
  Implementation of a teledermatology program at the Mann-Grandstaff Spokane VA Medical Center improved access to face-to-face dermatology care.
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, Washington.|2 Division of Dermatology, Department of Medicine, University of Washington , Seattle, Washington.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Raugi
authors.affiliation: 3 Spokane VA Medical Center , Spokane, Washington.
authors.forename: William
authors.initials: W
authors.lastname: Nelson
authors.affiliation: 3 Spokane VA Medical Center , Spokane, Washington.
authors.forename: Marion
authors.initials: M
authors.lastname: Miethke
authors.affiliation: 3 Spokane VA Medical Center , Spokane, Washington.
authors.forename: Marvin
authors.initials: M
authors.lastname: Boyd
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, Washington.
authors.forename: Craig
authors.initials: C
authors.lastname: Markham
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, Washington.
authors.forename: Brittany
authors.initials: B
authors.lastname: Dougall
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, Washington.
authors.forename: Dustin
authors.initials: D
authors.lastname: Bratten
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, Washington.
authors.forename: Tara
authors.initials: T
authors.lastname: Comer
mesh_terms: D000328:Adult; D003880:Dermatology / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019114:Remote Consultation / Q000458:organization & administration* / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000458:organization & administration* / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D014861:Washington; D055815:Young Adult
keywords: dermatology; teledermatology; telehealth; telemedicine