We have previously shown (IIR 95-045) that teledermatology, using store and forward technology, can result in reliable and accurate diagnostic outcomes when compared to clinic-based dermatology consultations. This investigation builds on that fundamental diagnostic information by assessing the health services implications of a teledermatology consult system.
To investigate health services outcomes related to teledermatology implementation. Outcomes of interest were time to diagnosis and treatment initiation, the proportion of patients that avoided the need for a clinic-based encounter, and an economic analysis.
Patients referred from the primary care clinics to the dermatology consult service were randomized to either usual care or a teledermatology consultation. A usual care consultation consisted a conventional text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the electronic text-based consult. Consultant dermatologists, reviewing the consult requests for both modalities, decided when, and if, a referral required a clinic-based evaluation.
Two hundred seventy-five patients were randomized; 135 to teledermatology and 140 to usual care. The median time to diagnosis and treatment initiation in the usual care arm was 127 days compared to 41 days in the teledermatology arm (p = 0.0001) for the intervention to treat analysis and was 137.5 versus 50 days, respectively (p = 0.0027) for the actual visit analysis. In the teledermatology arm, 18.5% of the patients were not scheduled for a clinic visit. From the VA perspective, teledermatology was cost-effective for decreasing the time required for patients to reach a time to diagnosis and treatment initiation. Cost-effectiveness ratios ranged from $0.12-$0.17 per patient day of time to diagnosis and treatment initiation saved.
Teledermatology consult systems can result in significantly shorter times to diagnosis and treatment initiation for patients compared to traditional consult modalities and, in some cases, the need for a clinic-based visit can be avoided. Teledermatology can achieve these outcomes in a cost-effective manner.
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- Whited JD. A teledermatology paradigm for evaluating telemedicine. Paper presented at: VA Career Development Award Program Annual Conference; 2003 Feb 12; Washington, DC.
- Whited JD. Teledermatology's Impact on Time Diagnosis and Treatment Initiative. Paper presented at: American Telemedicine Association Annual Meeting; 2002 Jun 3; Los Angeles, CA.
Epidemiology, Technology Development and Assessment
Randomized Controlled Trials, Telemedicine, Dermatology