Telemedicine improves dermatology outcomes
Wait times and costs are reduced for remote and Indigenous communities through the use of teledermatology (1,300 words, 6 minutes)
Teledermatology allows family physicians in communities without dermatologists to quickly consult a specialist, significantly reduce waitlists, and help care for patients unable to travel long distances for care, Dr. Jaggi Rao said in his presentation at the 8th annual Skin Spectrum Summit on September 17, 2022.
Dr. Rao is a clinical professor in the faculty of medicine at the University of Alberta in Edmonton and the founder and team lead of ConsultDerm, a Canadian national teledermatology project.
“Teledermatology is remote delivery of dermatologic care, whether that be diagnosis, workup, or treatment,” said Dr. Rao.
He said that adopting a telehealth approach allowed Dr. Rao to examine patients in the Northwest Territories from his home in Edmonton. The development of the internet and the increasing quality of smartphone cameras has allowed him to expand that into ConsultDerm, which now operates in five provinces.
Remote communities are not likely to have access to a dermatologist. Patients may be too sick or busy to travel to clinics in distant cities. However, Dr. Rao said, many health insurance plans may also require a dermatologist to approve advanced therapies for conditions such as psoriasis, atopic dermatitis, hidradenitis suppurativa, or urticaria. Teledermatology permits that step without making patients from remote areas travel long distances, even if patients must be qualified for advanced therapies by first being on medications such as methotrexate, which can be arranged via teledermatology.
Dr. Rao said ConsultDerm has set up teledermatology clinics for communities that lack a dermatologist. These clinics enlist local family physicians to act as the hands. At the same time, ConsultDerm provides the eyes, trains the physicians to perform specific procedures, and provides access to collections of dermatology images.
Dr. Rao said that teledermatology could also reduce waiting lists, allowing patients to see a specialist more quickly.
“In Alberta, the average consultation was 104 days... We reduced it to three days with [ConsultDerm],” he said. “In the ER, the turnover time sometimes is less than two minutes.”
ConsultDerm has also developed a philanthropic program for countries abroad, including in Africa.
Bottom Line: Teledermatology allows patients who may not have access to a dermatologist to be examined remotely by a specialist. This can be especially useful for patients unable to travel for health reasons and those in remote communities. For patients in remote communities who require advanced therapies, teledermatology can allow access to those treatments without taking a long and costly trip.
From the literature on teledermatology
Teledermatology may benefit marginalized populations: National and institutional trends during the Covid-19 pandemic
This retrospective study analyzed 13,964,816 dermatology encounters from U.S. national data (April 1, 2020, to June 30, 2021) and 54,400 encounters from the Duke University Health System (March 1, 2020, to April 30, 2021). Researchers compared teledermatology (TD) use vs. in-person healthcare use based on sex, race, age, generation, and in-state versus out-of-state location.
For the national data, sex, race, age, and location all had significant impacts on TD utilization. For the institutional data, sex, race, and age all had a considerable impact.
Overall, non-White, female and younger populations accounted for more significant percentages of TD utilizers.
Institutional no-show rates between telehealth and in-person visits were lower for Black patients, other non-White races, and younger ages/generations.
The authors conclude that understanding TD utilization trends is critical in defining the role of virtual care for improving universal care access, optimizing resources, and informing future healthcare models for all patient populations.
Teledermatology in rural, underserved, and isolated environments: A review
This review summarizes the current evidence for teledermatology (TD) in rural, underserved, and isolated environments, including its use during the current Covid-19 pandemic.
Topics covered include findings on cost-effectiveness and how TD can reduce face-to-face visits and improve the timeliness of care for medically underserved populations.
The authors cite recent studies that show additional benefits of TD, including improving health outcomes and increasing local providers' knowledge of dermatologic conditions.
However, the review also notes that low-income and rural populations still have limited access to digital technology and high-speed internet, limiting the reach of telemedical services.
Teledermatology and skin of colour patients
The authors of this paper detail several limitations facing patients with skin of colour in the U.S. regarding teledermatology (TD), including reduced internet access among underprivileged communities.
The authors cite a 2012 survey that found African-American respondents had elevated concerns with TD related to privacy issues and the doctor’s physical presence. In particular, many respondents said they felt less able to assess a physician’s competence and attention without physical presence.
The authors also note that while studies have examined the concordance rate between TD-based and in-person diagnoses, those studies have not stratified findings by skin type. They report the historically worse morbidity and mortality from skin cancer in darker skin types and the clinically different presentations of skin conditions in darker skin. The limited image clarity in TD may make diagnosing skin of colour patients even more challenging. The authors suggest there is a need for future studies that examine diagnostic concordance by skin type.
Effect of camera distance and angle on colour of diverse skin tone-based standards in smartphone photos
The authors of this paper note that camera distance and angle can impact the appearance of colour in clinical photographs. To explore how geometry affects colour, researchers quantified the change in CIELAB colour value of a colour standard for diverse skin tones at varying smartphone camera distances and angles.
They found that both chromaticity (a* and b*) and lightness (L*) were affected by angle, while distance only affected L*. Using a flash did not generally reduce the variability introduced by distance and angle.
Raw images (DNG format) also had less median variability than compressed (JPG) format images across different distances and angles.
VIDEO: Risks and benefits of AI in teledermatology
At the intersection of skin and society
On February 15, 2023, Statistics Canada released a report that found substantial variability in the risk of dying by different causes of death between Black and White Canadians.
The report is based on data from the 2001, 2006, and 2011 Canadian Census Health and Environmental Cohorts (CanCHECs).
According to the report, ischemic heart disease mortality was the leading cause of death among adult Black males (12.9%) and females (9.8%), as it is for adult White males (16.4%) and females (12.4%).
While the risk of all-cause mortality was reduced among Black males and females, compared to White cohort members, there was a significantly increased risk for some cause-specific mortality.
In an age-adjusted model, among the 25 causes of death examined, Black males had an increased risk of dying from four causes (HIV/AIDS, prostate cancer, diabetes mellitus, and cerebrovascular disease) compared to White males.
Similarly, Black females were at an increased risk for six causes of death (HIV/AIDS, stomach cancer, corpus uteri cancer, lymphomas and multiple myeloma, diabetes mellitus, and endocrine disorders) out of the 27 causes of death examined. These relatively increased risks persisted for most causes of death after the researchers adjusted for differences in critical social determinants of health.
This week
February 28 is Rare Disease Day
March 1 is Zero Discrimination Day
March 1 is International Women of Colour Day
Something to think about in the week ahead…
— Aldous Huxley, English novelist, 1894-1963
Next week
At the inaugural Summit on Atopic Dermatitis virtual meeting on April 23, 2022. Dr. Marissa Joseph discussed the importance of changing the language around atopic dermatitis to be more inclusive of the condition’s morphology in darker skin tones.
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Dr. Kim Papp (Waterloo, Ont.) discusses recent research on the TYK2 inhibitor deucravacitinib as a treatment for psoriasis
A review of 2022’s new dermatology treatments, featuring interviews with Dr. Ben Barankin (Toronto), Dr. Kerri Purdy (Halifax), and Dr. Marlene Dytoc (Edmonton)
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