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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1010 — The Impact of Store and Forward Teledermatology on Skin Disease-Related Quality of Life

Whited JD, Harry S. Truman Memorial Veterans Hospital; Warshaw EM, Minneapolis VA Medical Center, University of Minnesota School of Medicine; Edison KE, University of Missouri School of Medicine, Harry S. Truman Memorial Veterans Hospital; Kapur K, and Thottapuratha L, Hines VA Medical Center; Cook BARaju SEngasser HPullen S, and Parks P, Minneapolis VA Medical Center

Objectives:
To determine if the mean change in patient quality of life, as rated by Skindex-16, differs between baseline and nine months for patients evaluated by store and forward teledermatology compared to a conventional clinic-based consult process.

Methods:
The study was a two-site randomized trial that used a simple randomization scheme stratified by site of enrollment. Patients being referred to a Dermatology Consult Service were randomized to teledermatology or conventional care. Skindex-16 was administered at baseline, three months, and nine months. Skindex-16 mean change scores were compared for each of its three subscales (symptoms, emotions, and functioning) and a composite score. A Skindex-16 change score of 10 points is considered clinically significant.

Results:
Three hundred ninety-two patients were enrolled with 196 patients randomizing to each group. There were no baseline differences between randomization groups in demographics or Skindex-16 scores. Data were available at nine months for 164 conventional care patients and for 161 subjects in the teledermatology group. For both randomization groups the mean change score was lower (improved) between baseline and nine months for all subscales and for the composite score. There was no evidence to suggest a significant difference in change scores between randomization assignments for the subscales or composite score. The composite score improved by 13.2 points (s.d. 21.6) for conventional care and by 11.8 points (s.d. 24.6) for teledermatology (p = 0.60). Similar results, with smaller change score differences, were found between baseline and three months.

Implications:
Quality of life, as measured by Skindex-16, improved for patients treated by both consult modalities over the course of the study. The level of improved quality of life was not significantly different between patients managed by store and forward teledermatology compared to conventional care.

Impacts:
As the Department of Veterans Affairs increases its reliance on telemedicine as a healthcare delivery model it is important to quantify how this impacts healthcare outcomes for Veterans. Quality of life is a principal health outcome measure for ambulatory dermatologic conditions. This study suggests that quality of life outcomes are not significantly influenced by whether Veterans’ skin conditions are managed by teledermatology or by conventional care.


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