title: Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting.
abstract: BACKGROUND
  The clinical value of teledermatology in the primary care setting remains relatively unknown.
  
  
  OBJECTIVE
  We sought to determine the impact of teledermatology on outpatient diagnosis, management, and access to dermatologic care in a resource-poor primary care setting.
  
  
  METHODS
  We performed a prospective study of store-and-forward teledermatology consults submitted between January and November 2013 from 11 underserved clinics in Philadelphia to the University of Pennsylvania using mobile devices and the Internet. We assessed diagnostic and management concordance between primary care providers and dermatologists, time to consult completion, anticipated level of dermatology input in the absence of teledermatology, and number of consults managed with teledermatology alone.
  
  
  RESULTS
  The study included 196 consults encompassing 206 dermatologic conditions. Diagnoses and management plans of primary care providers and dermatologists were fully concordant for 22% and 23% of conditions, respectively. The median time to consult completion was 14 (interquartile range 3-28) hours. At least 61% of consults would not otherwise have received dermatology input, and 77% of consults were managed with teledermatology alone.
  
  
  CONCLUSIONS
  Lack of a diagnostic gold standard, limited patient follow-up, and uncertain generalizability are limitations.
  
  
  CONCLUSIONS
  Teledermatology is an innovative and impactful modality for delivering dermatologic care to outpatients in resource-poor primary care settings.
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Nelson
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Junko
authors.initials: J
authors.lastname: Takeshita
authors.affiliation: Department of Dermatology, Carver College of Medicine at the University of Iowa, Iowa City, Iowa.
authors.forename: Karolyn A
authors.initials: KA
authors.lastname: Wanat
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Dr Bernett L. Johnson Jr Sayre Health Center, Philadelphia, Pennsylvania.
authors.forename: Kent D W
authors.initials: KD
authors.lastname: Bream
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: John H
authors.initials: JH
authors.lastname: Holmes
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Jonathan Lax Center, Philadelphia, Pennsylvania.
authors.forename: Helen C
authors.initials: HC
authors.lastname: Koenig
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rudolf R
authors.initials: RR
authors.lastname: Roth
authors.affiliation: Ambulatory Health Services, Philadelphia Department of Public Health, Philadelphia, Pennsylvania.
authors.forename: Anitha
authors.initials: A
authors.lastname: Vuppalapati
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: William D
authors.initials: WD
authors.lastname: James
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Internal Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: carrie.kovarik@uphs.upenn.edu.
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Kovarik
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D003880:Dermatology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015143:Philadelphia; D011320:Primary Health Care; D011446:Prospective Studies; D012871:Skin Diseases / Q000175:diagnosis / Q000628:therapy; D017216:Telemedicine; D014505:Urban Population
keywords: health care access; mobile; outpatient dermatology consultation; store-and-forward; technology; teledermatology; telemedicine