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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3063 — Increasing Access to Care for Rural Veterans in VISN 20 with TeleDermatology

McFarland LV (Puget Sound Veterans Administration Health Care System), Raugi G (Puget Sound Veterans Administration Health Care System), Reiber GE (Puget Sound Veterans Administration Health Care System)

A TeleDermatology quality improvement project was begun to increase access to dermatology care for the underserved rural Veteran population. Another objective was to increase the scope of practice for providers and imagers at rural community outpatient clinics (CBOCs) to allow independent dermatology healthcare.

Standardized asynchronous Store and Forward TeleDermatology protocols were used across 23 rural CBOCs. Interfacility consults using provider progress notes with attached images were sent to Dermatologists in Seattle. Directed patient care plans were returned to rural providers with benchmarked time limits. Patient care and follow-up were co-managed by rural providers and centralized Dermatologists. Medical care providers and technicians at these CBOCs were trained and tested over a 1-year period in dermatology diagnosis, patient treatment care plans, dermatology procedures and imaging skills.

Currently, 2,646 unique Veterans were seen by the TeleDermatology project (with 3,716 dermatology conditions). The mean consult return time was 1.96 days. Skin cancer was detected in 458 Veterans (including 31 melanomas), 960 minor procedures (liquid nitrogen treatments, electrocautery) and 387 major procedures (excisions, biopsies) were done. Most (73%) were done within 30-days of the initial visit. Rural providers showed a 30% increase in dermatology knowledge 9-months into the project and 90% completed surgical training in basic dermatology procedures. Access to rural dermatology care resulted in fewer referrals to distant VA facilities, fewer transportation issues for rural Veterans and earlier detection of skin conditions.

Early results indicate that a TeleDermatology program is feasible and its availability increases dermatology care at rural CBOCs. Training for medical providers and technicians is feasible over web-based curriculum and conference calls, along with face-to-face training for dermatologic procedures.

Teledermatology may offer a mechanism to increase dermatology care to Veterans in rural settings. Training of VA providers in dermatology diagnosis and patient care plans, along with increased skills in basic dermatologic procedures is feasible. Teledermatology may provide a solution to unmet healthcare needs in Veterans in rural areas.

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