title: Impact of a store-and-forward teledermatology intervention versus usual care on delay before beginning treatment: A pragmatic cluster-randomized trial in ambulatory care.
abstract: Introduction In France, 66% of patients forego getting specialized care by dermatologists because of difficulty obtaining appointments. Store-and-forward teledermatology could improve how promptly treatment begins by reducing the delay in obtaining a specialist's opinion. In this study, we compared the delay before care between general practitioners (GPs) using a store-and-forward teledermatology intervention and GPs addressing their patients with a standard referral letter. Methods We performed an open-label, pragmatic cluster-randomized controlled trial with two parallel arms. GP clinics in Paris (France) were randomly assigned to use either teledermatology referral (use of electronics to send clinical images taken using a mobile phone) or conventional referral (using standard letters) to care for patients for whom a dermatologist's advice was needed for the diagnosis or treatment of skin lesions. Dermatologists integrated responses to teledermatology requests in their usual schedule. Patients were followed up for three months. Primary outcome was the delay, in days, between the GP's consultation and a reply by the specialist allowing treatment to begin. Analyses were adjusted for clustering of GPs and identities of dermatologists. Results Between February and June 2014, 103 patients were included in the study (53 patients of 20 GPs in the intervention group). The median delay between the initial GP's consultation and the reply allowing for treatment to begin was four days in the intervention group and 40 days in the control group (adjusted hazard ratio = 2.55; p < 0.011). Discussion We showed that a simple store-and-forward teledermatology intervention significantly reduced the delay before beginning care (ClinicalTrials.gov identifier: NCT02122432).
authors: 1 Department of General Medicine, Paris Diderot University, Paris, France.|2 Sorbonne Paris Cité University, Paris, France.
authors: Edouard
authors: E
authors: Piette
authors: 1 Department of General Medicine, Paris Diderot University, Paris, France.|2 Sorbonne Paris Cité University, Paris, France.
authors: Michel
authors: M
authors: Nougairède
authors: 2 Sorbonne Paris Cité University, Paris, France.|3 Department of Dermatology, Hospital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France.
authors: Valerie
authors: V
authors: Vuong
authors: 2 Sorbonne Paris Cité University, Paris, France.|3 Department of Dermatology, Hospital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France.
authors: Beatrice
authors: B
authors: Crickx
authors: 1 Department of General Medicine, Paris Diderot University, Paris, France.|2 Sorbonne Paris Cité University, Paris, France.|4 Centre de recherche en Epidémiologie et Statistiques, INSERM U1153, Paris, France.
authors: Viet-Thi
authors: VT
authors: Tran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D040421:Cell Phone; D003142:Communication; D003880:Dermatology / Q000458:organization & administration*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012871:Skin Diseases / Q000175:diagnosis*; D017216:Telemedicine / Q000458:organization & administration*; D013997:Time Factors; D055815:Young Adult
keywords: Teledermatology; teleconsulting