AT SID 2017

PORTLAND (FRONTLINE MEDICAL NEWS) – For uninsured patients with limited health care access, a teledermatology triage protocol cut average appointment wait times by ninefold, and usually provided adequate dermatologic care without the need for in-person follow-up, Peter B. Chansky reported at the annual meeting of the Society for Investigative Dermatology.

“In our study, teledermatology was sufficient to triage 70% of cases, which significantly reduced time to evaluation, increased the availability of in-person appointments, and provided a new chance for volunteer dermatologists to serve disadvantaged populations that do not have access to specialty providers,” Mr. Chansky, a medical student at the University of Pennsylvania, Philadelphia, said during an oral presentation of his poster.

Puentes de Salud is a nonprofit, multidisciplinary health care clinic that serves uninsured Latino immigrants in southern Philadelphia, explained Mr. Chansky, who conducted the study under the mentorship of Jules B. Lipoff, MD , of the department of dermatology, at the University of Pennsylvania. Volunteer dermatologists hold a clinic at Puentes de Salud once per month, but patients’ need substantially outpaces supply, which has fueled long wait times and delays in care.

To test an alternative, the volunteer dermatologists created a “teletriage” system for primary care providers to turn to first, before attempting to schedule in-person dermatology appointments at Puentes de Salud. The results were striking: Teledermatology cut average wait times by a factor of 9.3, and patients who typically had gone months with unevaluated skin lesions waited an average of 1.4 days (standard deviation, 3.1 days) for a teledermatology consult, instead of 13.4 days (SD, 1.9 days) for an in-person appointment (P less than .0001).

Just as notably, teledermatologists changed or expanded on 70% of primary care providers’ diagnoses and altered their treatment plans 95% of the time. “Teledermatology also reclaimed 18% of monthly in-person clinic appointments for patients who needed face-to-face consultation,” Mr. Chansky said. “Access to dermatologic care is especially limited among uninsured patients, and using teledermatology to triage patients in a volunteer free clinic has never been evaluated,” he noted.

The analysis included 60 teletriage referrals from nurses and physicians over 2.5 years. Patients were usually male, averaged 32 years in age, and reported an average symptom duration of 15 months. Most lesions had not previously been treated. Cases were usually inflammatory in nature (45%), while 18% were neoplastic, 17% were infectious, and 8% were pigmented lesions. Lesions were usually located on visible areas of skin, including the face, hands, and arms.

This protocol relied on volunteer dermatologists, but teletriage repeatedly has been shown to provide effective dermatologic care in a variety of health care settings, Mr. Chansky noted. “Teledermatology is an accurate, cost-effective, and efficient tool for improving access to dermatologic care,” he added.

Mr. Chansky did not acknowledge external funding sources and had no conflicts of interest.