1
|
Van Enst WA, Weng YC, Wanten SAC, Seyger MMB, Baerveldt EM, Arents BWM, De Jong EMGJ, Van den Reek JMPA. Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review. Acta Derm Venereol 2024; 104:adv23901. [PMID: 38751176 PMCID: PMC11110807 DOI: 10.2340/actadv.v104.23901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/14/2024] [Indexed: 05/24/2024] Open
Abstract
Telemedicine, the provision of remote healthcare, has gained prominence, accelerated by the COVID-19 pandemic. It has the potential to replace routine in-person follow-up visits for patients with chronic inflammatory skin conditions. However, it remains unclear whether telemedicine can effectively substitute in-person consultations for this patient group. This systematic review assessed the effectiveness and safety of telemedicine compared with traditional in-person care for chronic inflammatory skin diseases. A comprehensive search in various databases identified 11 articles, including 5 randomized controlled trials (RCTs) and 1 clinical controlled trial (CCT). These studies evaluated telemedicine's impact on patients with psoriasis and atopic dermatitis, with varying methods like video consultations and digital platforms. The findings tentatively suggest that telemedicine does not seem to be inferior compared with in-person care, particularly in terms of condition severity and quality of life for patients with chronic inflammatory skin diseases. However, these results should be interpreted with caution due to the inherent uncertainties in the evidence. There are indications that telemedicine can offer benefits such as cost-effectiveness, time savings, and reduced travel distances, but it is important to recognize these findings as preliminary, necessitating further validation through more extensive research.
Collapse
Affiliation(s)
| | - Ying Chao Weng
- Dutch Society for Dermatology and Venereology, Utrecht, The Netherlands
| | - Sophie A C Wanten
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marieke M B Seyger
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Bernd W M Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, The Netherlands
| | - Elke M G J De Jong
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
2
|
Tian J, Zhang L, Zhao X, Yang L. Knowledge, attitude, and practice of psoriasis patients toward their diseases: a web-based, cross-sectional study. Front Med (Lausanne) 2024; 11:1288423. [PMID: 38660417 PMCID: PMC11040075 DOI: 10.3389/fmed.2024.1288423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
Objective To investigate the knowledge, attitude, and practice (KAP) of psoriasis patients toward the disease. Methods A web-based cross-sectional study was conducted among psoriasis patients who were diagnosed at the outpatient of Shaanxi Provincial People's Hospital in March 2023. A self-designed questionnaire was administered for data collection and KAP assessment. Results A total of 526 valid questionnaires were included, including 257 males (48.86%) psoriasis patients. Their mean KAP scores were 8.09 ± 3.60 (possible range: 0-12), 31.94 ± 4.61 (possible range: 10-50), and 51.92 ± 8.83 (possible range: 15-75), respectively. Pearson's correlation analysis showed a positive correlation between knowledge and attitude (r = 0.186, p < 0.001), a positive correlation between knowledge and practice (r = 0.313, p < 0.001), and a negative correlation between attitude and practice (r = -0.181, p < 0.001). Moreover, structural equation model showed that medication (β = 2.74, 95% CI: 2.17, 3.32, p < 0.001) has significantly positive effect on knowledge. Education (β = 0.56, 95% CI: 0.31, 0.81, p < 0.001) and duration of psoriasis (β = 1.01, 95% CI: 0.54, 1.49, p < 0.001) have significantly positive effect on attitude. Knowledge (β = 1.03, 95% CI: 0.80, 1.26, p < 0.001) and medication (β = 4.59, 95% CI: 2.78, 6.40, p < 0.001) has significantly positive effect on practice, while attitude (β = -0.41, 95% CI: -0.57, -0.26, p < 0.001) and duration of psoriasis (β = -2.53, 95% CI: -3.49, -1.57, p < 0.001) exhibit significantly negative effect on practice. Conclusion Psoriasis patients have good knowledge, positive attitude, and proactive practice toward the disease. Education, medication, duration of psoriasis might have effect on their KAP.
Collapse
Affiliation(s)
- Jun Tian
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Lei Zhang
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xiangrong Zhao
- Shaanxi Provincial Key Laboratory of Infection and Immune Diseases, Xi’an, China
| | - Li Yang
- Department of Dermatology, Shaanxi Provincial People’s Hospital, Xi’an, China
| |
Collapse
|
3
|
Jasly K, Goyal S, Ashwini PK, Kanthraj GR, Chethana SG, Ranugha S. Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study. Indian J Dermatol Venereol Leprol 2024; 0:1-7. [PMID: 38594974 DOI: 10.25259/ijdvl_118_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/10/2023] [Indexed: 04/11/2024]
Abstract
Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aims To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitations A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.
Collapse
Affiliation(s)
- Kuttiali Jasly
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Sakshi Goyal
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - P K Ashwini
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Garehatty Rudrappa Kanthraj
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - S Gurumurthy Chethana
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Subramaniam Ranugha
- Department of Dermatology, Venereology & Leprosy, JSS Medical College, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| |
Collapse
|
4
|
Augustin M, Reinders P, Janke TM, Strömer K, von Kiedrowski R, Kirsten N, Zink A, Otten M. Attitudes Toward and Use of eHealth Technologies Among German Dermatologists: Repeated Cross-Sectional Survey in 2019 and 2021. J Med Internet Res 2024; 26:e45817. [PMID: 38345855 PMCID: PMC10897787 DOI: 10.2196/45817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/29/2023] [Accepted: 10/17/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND In recent years, legal and infrastructural conditions have been set to improve the adoption of digital applications in health care in Germany. The impact of these actions was amplified by the COVID-19 pandemic. So far, no studies have confirmed this progress in dermatology. OBJECTIVE The aim of this study was to measure changes in knowledge, interest, expectation, and use of digital applications in health care among dermatologists in Germany in 2019 and 2021. METHODS We administered a repeated cross-sectional survey among dermatologists in medical practices and clinics in Germany at 2 time points: t1 (2019; before the COVID-19 pandemic) and t2 (2021; during the COVID-19 pandemic). We used a standardized questionnaire, including items on respondents' knowledge, interest, expectation, and use of digital applications, as well as their demographics. The survey was distributed by post and email. The data were analyzed descriptively as well as with multiple logistic regressions. RESULTS At t1, 585 (272/571, 47.6% female; mean age 52.4, SD 8.9 years) dermatologists and at t2, 792 (360/736, 48.9% female; mean age 54.3, SD 8.6 years) dermatologists participated in this survey. Interest in digital medicine was higher at t1 than at t2 (381/585, 65.1% vs 458/792, 57.8%; P≤.001). Nevertheless, 38.6% (306/792) had used digital applications more often since the beginning of the pandemic. For example, real-time telemedicine with patients (12/585, 2.1% vs 160/792, 7.6%; P≤.001) and other specialists did increase (33/385, 5.7% vs 181/792, 22.8%; P≤.001). Almost one-third expressed great concerns about digitalization (272/792, 34.3% vs 294/792, 37.1%; P=.21). Spatial analysis revealed higher interest in, more positive expectations toward, and higher use of digital applications in urban areas in comparison to rural areas. For instance, dermatologists from urban areas assessed future applications as having less risk (adjusted odds ratio [aOR] 0.51, 95% CI 0.35-0.76) than did dermatologists from rural areas. The situation was similar with the age groups, as, for example, dermatologists aged <50 years also expected lower risks (aOR 0.51, 95% CI 0.34-0.77) than those aged ≥50 years. There were no differences between sexes in use, but there were differences in knowledge and expectation; for example, male participants assessed their confidence in using digital applications as higher (aOR 1.44, 95% CI 1.01-2.04) than did female participants. CONCLUSIONS During the pandemic, the use of digital applications in dermatology increased but still remained at a moderate level. The regional and age-related disparities identified indicate the need for further action to ensure equal access to digital care.
Collapse
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Patrick Reinders
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Toni Maria Janke
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | | | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy, School of Medicine Technical University of Munich, Munich, Germany
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
5
|
Hwang JK, Del Toro NP, Han G, Oh DH, Tejasvi T, Lipner SR. Review of Teledermatology: Lessons Learned from the COVID-19 Pandemic. Am J Clin Dermatol 2024; 25:5-14. [PMID: 38062339 DOI: 10.1007/s40257-023-00826-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 01/23/2024]
Abstract
Utilization of telemedicine for dermatology has greatly expanded since the start of the COVID-19 pandemic, with over 500 new teledermatology studies published since 2020. An updated review on teledermatology is necessary to incorporate new findings and perspectives, and educate dermatologists on effective utilization. We discuss teledermatology in terms of diagnostic accuracy and clinical outcomes, patient and physician satisfaction, considerations for special patient populations, published practice guidelines, cost effectiveness and efficiency, as well as administrative regulations and policies. Our findings emphasize the need for dermatologist education, prioritization of reliable reimbursement systems, and technological innovations to support the continued development of teledermatology in the post-pandemic era.
Collapse
Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Natalia Pelet Del Toro
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - George Han
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Ave, New Hyde Park, NY, 11042, USA
| | - Dennis H Oh
- Department of Dermatology, University of California, San Francisco, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Medicine, 1910 Taubman Center, Ann Arbor, MI, 48109, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA.
| |
Collapse
|
6
|
Culmer N, Smith TB, Stager C, Wright A, Fickel A, Tan J, Clark C(T, Meyer H, Grimm K. Asynchronous Telemedicine: A Systematic Literature Review. TELEMEDICINE REPORTS 2023; 4:366-386. [PMID: 38143795 PMCID: PMC10739789 DOI: 10.1089/tmr.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/26/2023]
Abstract
Background Asynchronous telemedicine (ATM), which describes telemedical interaction between a patient and provider where neither party communicates simultaneously, is an important telemedicine modality that is seeing increased use. In this article, we summarize the published peer-reviewed literature specifically related to ATM to (1) identify terms or phrases that are used to describe ATM, (2) ascertain how this research has thus far addressed the various aspects of the quadruple aim of medicine, and (3) assess the methodological rigor of research on ATM. We also divided the literature into pre- and post-COVID-19 onset periods to identify potential variations in the literature between these two periods. Methods This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search, utilizing multiple databases and applying inclusion and exclusion criteria, initially produced 2624 abstracts for review. De-duplication and screening ultimately yielded 104 articles for data extraction. Results "Store-and-forward" and variations of "e-visit" were the most frequently used alternative terms for ATM. Care quality was the most frequently addressed aspect of the Quadruple Aim of Medicine-more than double any other category-followed by patient satisfaction. We separated cost of care into two categories: patients' cost of care and providers' cost to provide care. Patient cost of care was the third most addressed aspect of the Quadruple Aim of Medicine followed by provider well-being and provider's cost to provide care. Methodological rigor of the studies was also addressed, with only 2 quantitative studies ranked "Strong," 5 ranked "Moderate," and 97 ranked "Weak." Qualitative studies were generally acceptable but struggled methodologically with accounting for all participants and articulation of results. Conclusions Although "store-and-forward" is somewhat more frequently used in the studies included in this review, variants of "e-visit," are growing in recent usage. Given the relative newness of modality, it is not surprising that quality of care is the most researched aspect of the Quadruple Aim of Medicine in ATM research. We anticipate more balance between these areas as research in this field matures. Primary areas of research need currently relate to practitioners-specifically their costs of providing care and well-being. Finally, future ATM research needs to address research challenges of selection bias and blinding in quantitative studies and improved participant tracking and articulation of both study design and results in qualitative studies.
Collapse
Affiliation(s)
- Nathan Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Catanya Stager
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Andrea Wright
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Jet Tan
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | | - Hannah Meyer
- The University of Alabama, Tuscaloosa, Alabama, USA
| | | |
Collapse
|
7
|
Liu Z, Wang X, Ma Y, Lin Y, Wang G. Artificial intelligence in psoriasis: Where we are and where we are going. Exp Dermatol 2023; 32:1884-1899. [PMID: 37740587 DOI: 10.1111/exd.14938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
Artificial intelligence (AI) is a field of computer science that involves the development of programs designed to replicate human cognitive processes and the analysis of complex data. In dermatology, which is predominantly a visual-based diagnostic field, AI has become increasingly important in improving professional processes, particularly in the diagnosis of psoriasis. In this review, we summarized current AI applications in psoriasis: (i) diagnosis, including identification, classification, lesion segmentation, lesion severity and area scoring; (ii) treatment, including prediction treatment efficiency and prediction candidate drugs; (iii) management, including e-health and preventive medicine. Key challenges and future aspects of AI in psoriasis were also discussed, in hope of providing potential directions for future studies.
Collapse
Affiliation(s)
- Zhenhua Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xinyu Wang
- Department of Economics, Finance and Healthcare Administration, Valdosta State University, Valdosta, Georgia, USA
| | - Yao Ma
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, China
| | - Yiting Lin
- Department of Dermatology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
8
|
Jin JQ, Hong J, Elhage KG, Braun M, Spencer RK, Chung M, Yeroushalmi S, Hadeler E, Mosca M, Bartholomew E, Hakimi M, Davis MS, Thibodeaux Q, Wu D, Kahlon A, Dhaliwal P, Mathes EF, Dhaliwal N, Bhutani T, Liao W. Development of SkinTracker, an integrated dermatology mobile app and web portal enabling remote clinical research studies. Front Digit Health 2023; 5:1228503. [PMID: 37744686 PMCID: PMC10516539 DOI: 10.3389/fdgth.2023.1228503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction In-person dermatology clinical research studies often face recruitment and participation challenges due to travel-, time-, and cost-associated barriers. Studies incorporating virtual/asynchronous formats can potentially enhance research subject participation and satisfaction, but few mobile health tools are available to enable remote study conduct. We developed SkinTracker, a patient-facing mobile app and researcher-facing web platform, that enables longitudinal collection of skin photos, patient reported outcomes, and biometric health and environmental data. Methods Eight design thinking sessions including dermatologists, clinical research staff, software engineers, and graphic designers were held to create the components of SkinTracker. Following iterative prototyping, SkinTracker was piloted across six adult and four pediatric subjects with atopic dermatitis (AD) of varying severity levels to test and provide feedback on SkinTracker for six months. Results The SkinTracker app enables collection of informed consent for study participation, baseline medical history, standardized skin photographs, patient-reported outcomes (e.g., Patient Oriented Eczema Measure (POEM), Pruritus Numerical Rating Scale (NRS), Dermatology Life Quality Index (DLQI)), medication use, adverse events, voice diary to document qualitative experiences, chat function for communication with research team, environmental and biometric data such as exercise and sleep metrics through integration with an Apple Watch. The researcher web portal allows for management and visualization of subject enrollment, skin photographs for examination and severity scoring, survey completion, and other patient modules. The pilot study requested that subjects complete surveys and photographs on a weekly to monthly basis via the SkinTracker app. Afterwards, participants rated their experience in a 7-item user experience survey covering app function, design, and desire for participation in future studies using SkinTracker. Almost all subjects agreed or strongly agreed that SkinTracker enabled more convenient participation in skin research studies compared to an in-person format. Discussion To our knowledge, SkinTracker is one of the first integrated app- and web-based platforms allowing collection and management of data commonly obtained in clinical research studies. SkinTracker enables detailed, frequent capture of data that may better reflect the fluctuating course of conditions such as AD, and can be modularly customized for different skin conditions to improve dermatologic research participation and patient access.
Collapse
Affiliation(s)
- Joy Q. Jin
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Julie Hong
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Kareem G. Elhage
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchell Braun
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Riley K. Spencer
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mimi Chung
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Samuel Yeroushalmi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward Hadeler
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Megan Mosca
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Erin Bartholomew
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Marwa Hakimi
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchell S. Davis
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Quinn Thibodeaux
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - David Wu
- School of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Erin F. Mathes
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Tina Bhutani
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
9
|
Das AK, Chang E, Paydar C, Broder MS, Orroth KK, Cordey M. Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic. Dermatol Ther (Heidelb) 2023; 13:1973-1984. [PMID: 37392261 PMCID: PMC10442297 DOI: 10.1007/s13555-023-00967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/12/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION Limited access to healthcare during the COVID-19 pandemic prompted patients to seek care using telehealth. In this study, we assessed whether treatment patterns differed for patients with psoriasis (PsO) or psoriatic arthritis (PsA) initiating apremilast by either a telehealth or an in-person visit. METHODS We estimated adherence and persistence among US patients in the Merative© MarketScan© Commercial and Supplemental Medicare Databases who newly initiated apremilast between April and June 2020, categorized by the type of visit (telehealth or in-person) when apremilast was first prescribed. Adherence was defined as the proportion of days covered (PDC), with PDC ≥ 0.80 considered to indicate high adherence. Persistence was defined as having apremilast available to take without a 60-day gap during follow-up. Factors associated with high adherence and persistence were estimated with logistic and Cox regression. RESULTS Among apremilast initiators (n = 505), the mean age was 47.6 years, 57.8% were female, and the majority had PsO (79.6%). Telehealth index visits were more likely among patients residing in Northeast USA (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.63-6.71) and Western USA (OR 2.52, 95% CI 1.07-5.93]), those with a prescribing rheumatologist (OR 2.27, 95% CI 1.10-4.68), and those with any baseline telehealth visit (OR 1.91, 85% CI 1.20-3.04). Those initiating apremilast with a telehealth visit (n = 141) had similar mean PDC to those initiating apremilast with an in-person visit (n = 364) (0.695 vs. 0.728; p = 0.272). At the end of the 6-month follow-up, 54.3% of the overall population had high adherence (PDC ≥ 0.80) and 65.1% were persistent. After adjusting for potential confounders, patients initiating apremilast via telehealth had similar full adherence (OR 0.80, 95% CI 0.52-1.21) and persistence as those initiating apremilast in-person. CONCLUSION Patients with PsO and patients with PsA initiating apremilast via telehealth or in-person during the COVID-19 pandemic had similar medication adherence and persistence during the 6-month follow-up period. These data suggest that patients initiating apremilast can be as effectively managed with telehealth visits as with in-person visits.
Collapse
Affiliation(s)
- Ashis K. Das
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Eunice Chang
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Caleb Paydar
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | - Michael S. Broder
- PHAR (Partnership for Health Analytics Research), 280 S Beverly Dr, Beverly Hills, CA 90212 USA
| | | | | |
Collapse
|
10
|
Bourkas AN, Barone N, Bourkas MEC, Mannarino M, Fraser RDJ, Lorincz A, Wang SC, Ramirez-GarciaLuna JL. Diagnostic reliability in teledermatology: a systematic review and a meta-analysis. BMJ Open 2023; 13:e068207. [PMID: 37567745 PMCID: PMC10423833 DOI: 10.1136/bmjopen-2022-068207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVES To compare teledermatology and face-to-face (F2F) agreement in primary diagnoses of dermatological conditions. DESIGN Systematic review and meta-analysis METHODS: MEDLINE, Embase, Cochrane Library (Wiley), CINAHL and medRxiv were searched between January 2010 and May 2022. Observational studies and randomised clinical trials that reported percentage agreement or kappa concordance for primary diagnoses between teledermatology and F2F physicians were included. Titles, abstracts and full-text articles were screened in duplicate. From 7173 citations, 44 articles were included. A random-effects meta-analysis was conducted to estimate pooled estimates. Primary outcome measures were mean percentage and kappa concordance for assessing diagnostic matches between teledermatology and F2F physicians. Secondary outcome measures included the agreement between teledermatologists, F2F dermatologists, and teledermatology and histopathology results. RESULTS 44 studies were extracted and reviewed. The pooled agreement rate was 68.9%, and kappa concordance was 0.67. When dermatologists conducted F2F and teledermatology consults, the overall diagnostic agreement was significantly higher at 71% compared with 44% for non-specialists. Kappa concordance was 0.69 for teledermatologist versus specialist and 0.52 for non-specialists. Higher diagnostic agreements were also noted with image acquisition training and digital photography. The agreement rate was 76.4% between teledermatologists, 82.4% between F2F physicians and 55.7% between teledermatology and histopathology. CONCLUSIONS AND RELEVANCE Teledermatology can be an attractive option particularly in resource-poor settings. Future efforts should be placed on incorporating image acquisition training and access to high-quality imaging technologies. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/FJDVG.
Collapse
Affiliation(s)
| | - Natasha Barone
- Faculty of Medicine and Health Sciences, McGill University Montreal, Montreal, Quebec, Canada
| | | | | | - Robert D J Fraser
- Nursing, Western University Arthur Labatt Family School of Nursing, London, Ontario, Canada
- Swift Medical, Toronto, Ontario, Canada
| | - Amy Lorincz
- Independent Researcher, Montreal, Qubec, Canada
| | - Sheila C Wang
- Swift Medical, Toronto, Ontario, Canada
- Dermatology, McGill University Department of Medicine, Montreal, Qubec, Canada
| | | |
Collapse
|
11
|
Maul LV, Jahn AS, Pamplona GSP, Streit M, Gantenbein L, Müller S, Nielsen ML, Greis C, Navarini AA, Maul JT. Acceptance of Telemedicine Compared to In-Person Consultation From the Providers' and Users' Perspectives: Multicenter, Cross-Sectional Study in Dermatology. JMIR DERMATOLOGY 2023; 6:e45384. [PMID: 37582265 PMCID: PMC10457706 DOI: 10.2196/45384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/15/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Teledermatology is currently finding its place in modern health care worldwide as a rapidly evolving field. OBJECTIVE The aim of this study was to investigate the acceptance of teledermatology compared to in-person consultation from the perspective of patients and professionals. METHODS This multicenter, cross-sectional pilot study was performed at secondary and tertiary referral centers of dermatology in Switzerland from August 2019 to January 2020. A customized questionnaire addressing demographics and educational data, experience with telemedicine, and presumed willingness to replace in-patient consultations with teledermatology was completed by dermatological patients, dermatologists, and health care workers in dermatology. RESULTS Among a total of 664 participants, the ones with previous telemedicine experience (171/664, 25.8%) indicated a high level of overall experience with it (patients: 73/106, 68.9%, dermatologists: 6/8, 75.0%, and health care workers: 27/34, 79.4%). Patients, dermatologists, and health care workers were most likely willing to replace in-person consultations with teledermatology for minor health issues (353/512, 68.9%; 37/45, 82.2%; and 89/107, 83.2%, respectively). We observed a higher preference for telemedicine among individuals who have already used telemedicine (patients: P<.001, dermatologists: P=.03, and health care workers, P=.005), as well as among patients with higher educational levels (P=.003). CONCLUSIONS This study indicates that the preference for teledermatology has a high potential to increase over time since previous experience with telemedicine and a higher level of education were associated with a higher willingness to replace in-patient consultations with telemedicine. We assume that minor skin problems are the most promising issue in teledermatology. Our findings emphasize the need for dermatologists to be actively involved in the transition to teledermatology. TRIAL REGISTRATION ClinicalTrials.gov NCT04495036; https://classic.clinicaltrials.gov/ct2/show/NCT04495036.
Collapse
Affiliation(s)
- Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Anna Sophie Jahn
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Gustavo S P Pamplona
- Jules-Gonin Eye Hospital/Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
- Rehabilitation Engineering Laboratory (RELab), Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Markus Streit
- Department of Dermatology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Lorena Gantenbein
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Simon Müller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Mia-Louise Nielsen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Christian Greis
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Gierek M, Kitala D, Łabuś W, Glik J, Szyluk K, Pietrauszka K, Bergler-Czop B, Niemiec P. The Impact of Telemedicine on Patients with Hidradenitis Suppurativa in the COVID-19 Era. Healthcare (Basel) 2023; 11:healthcare11101453. [PMID: 37239740 DOI: 10.3390/healthcare11101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Hidradenitis suppurativa is a chronic, inflammatory skin disease. It is characterized by the transformation of normal skin into skin with abscesses, nodules, tunnels, and scars. The most commonly affected areas are the armpits, groins, buttocks, and subscapular area. Patients with HS require constant care under the supervision of the outpatient clinic. Due to the COVID-19 pandemic, consultations have been introduced in the form of telemedicine. The aim of this study was to evaluate the availability of HS treatment during the COVID-19 pandemic and to assess patient satisfaction, problems with access to medical care, and the impact of the pandemic on the course of the disease. (2) Methods: An internet survey with an anonymous questionnaire was used to assess the effectiveness of telemedicine consultations. The survey consisted of 25 closed questions, and responses were kept fully anonymous. (3) Results: Most respondents reported minor problems with accessing specialized HS medical care during the COVID-19 pandemic (n = 25, 35.71%). However, 35.71% (n = 25) of them reported major problems with appointments for specialized ambulatory treatment during the last few months of the pandemic, mainly due to delayed appointments. Almost half of the respondents had been diagnosed with COVID-19 (n = 34, 48.57%), and 58.57% (n = 41) of respondents did not see a correlation between COVID-19 infection and HS progression. (4) Conclusions: Our study showed that the pandemic significantly limited access to medical advice, and patients with hidradenitis suppurativa prefer standard consultations.
Collapse
Affiliation(s)
- Marcin Gierek
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Diana Kitala
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Wojciech Łabuś
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Justyna Glik
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
- Department of Organisation of Chronic Wound Healing, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Street, 41-940 Piekary Slaskie, Poland
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street, 40-027 Katowice, Poland
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street, 40-027 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland
| |
Collapse
|
13
|
Martora F, Fabbrocini G, Megna M, Scalvenzi M, Battista T, Villani A, Potestio L. Teledermatology for Common Inflammatory Skin Conditions: The Medicine of the Future? Life (Basel) 2023; 13:life13041037. [PMID: 37109566 PMCID: PMC10146182 DOI: 10.3390/life13041037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/09/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic period revolutionized daily clinical practice. Several strategies were adopted by clinicians to avoid reducing treatment for diseases without the risk of spreading the infection. Among the adopted strategies, telemedicine played a key role. In this scenario, several tools were used, including e-mails, phone calls, video calls, support groups, and messages. Fortunately, the COVID-19 pandemic period seems to be at an end. However, the use of teledermatology appears to be an excellent strategy for the future as well. Indeed, several patients may benefit from teledermatology. OBJECTIVE In this manuscript, we aim to investigate the use of telemedicine in the dermatological field to point out how this tool may become the mainstay of future medicine. Only the use of teledermatology with common inflammatory skin conditions have been reported herein. MATERIALS AND METHODS Investigated manuscripts included metanalyses, reviews, letters to the editor, real-life studies, case series, and reports. Manuscripts were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. RESULTS A total of 121 records were identified from the analyzed databases. However, only 110 articles were assessed for eligibility. Finally, 92 articles were selected at the end of the literature research for our review. CONCLUSIONS Teledermatology should be considered as a viable option for the dermatologist for the future. We believe that the pandemic has strengthened this service, and this will allow for ever better development in the future. Guidelines regarding the use of teledermatology are required as well as additional improvements for the future.
Collapse
Affiliation(s)
- Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy
| |
Collapse
|
14
|
Low ZM, Koye DN, Haurat J, Ioppi B, Antunes E, Fazio TN, Nicolopoulos J, Dolianitis C, Howard A, Radulski B, Scardamaglia L, Morgan V, Kern JS. Evaluation of teledermatology during a pandemic: Assessing patient satisfaction, cost evaluation and clinical effectiveness. Australas J Dermatol 2023; 64:e185-e188. [PMID: 36802058 DOI: 10.1111/ajd.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/22/2022] [Accepted: 01/29/2023] [Indexed: 02/20/2023]
Affiliation(s)
- Z M Low
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D N Koye
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - J Haurat
- BioGRID Australia, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - B Ioppi
- Telehealth Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - E Antunes
- Health Intelligence Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Timothy N Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - J Nicolopoulos
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - C Dolianitis
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - A Howard
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - B Radulski
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - L Scardamaglia
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - V Morgan
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - J S Kern
- Dermatology Department, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Dermatology, Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Snyder AM, Chen SC, Chren MM, Ferris LK, Edwards LD, Swerlick RA, Flint ND, Cizik AM, Hess R, Kean J, Secrest AM. Patient-Reported Outcome Measures and Their Clinical Applications in Dermatology. Am J Clin Dermatol 2023:10.1007/s40257-023-00758-8. [PMID: 36723756 PMCID: PMC9890442 DOI: 10.1007/s40257-023-00758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/02/2023]
Abstract
With more disease- and symptom-specific measures available and research pointing to increased usefulness, patient-reported outcome measures (PROMs) can be routinely used in clinical care. PROMs increase efficiency in healthcare, improve the clinician-patient relationship, and increase patient satisfaction with their care. PROMs can be administered before, during, and after clinic visits using paper-and-pencil, mobile phones, tablets, and computers. Herein, we combine available literature with expert views to discuss overcoming barriers and helping dermatologists incorporate PROMs into routine patient-centered care. We believe dermatology patients will benefit from broader PROM implementation and routine clinical use. However, a few major barriers exist: (1) cost to implement the technology, (2) selecting the right PROMs for each disease, and (3) helping both patients and clinicians understand how PROMs add to and complement their current clinical experience. We provide recommendations to assist dermatologists when considering whether to implement PROMs in their practices.
Collapse
Affiliation(s)
- Ashley M Snyder
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
| | - Suephy C Chen
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - LaVar D Edwards
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- SyTrue, Inc., Stateline, NV, USA
| | | | - Nicholas D Flint
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA
| | - Amy M Cizik
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA
| | - Aaron M Secrest
- Department of Dermatology, University of Utah, 30 N 1900 East, 4A330, Salt Lake City, UT, 84132, USA.
- Department of Population Health Sciences, University of Utah, UT, Salt Lake City, USA.
- Department of Dermatology, Canterbury District Health Board, Health New Zealand, Christchurch, New Zealand.
| |
Collapse
|
16
|
Young PM, Chen AY, Ford AR, Cheng MY, Lane CJ, Armstrong AW. Effects of online care on functional and psychological outcomes in patients with psoriasis: A randomized controlled trial. J Am Acad Dermatol 2023; 88:364-370. [PMID: 31175908 DOI: 10.1016/j.jaad.2019.05.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/18/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND The impact of online care on patients' functional and psychological outcomes is critical to determine yet still unknown. OBJECTIVE To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving functional status and mental health of patients with psoriasis. METHODS This 12-month randomized controlled equivalency trial randomly assigned patients with psoriasis 1:1 to receive online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions index and Patient Health Questionnare-9. RESULTS Overall, 296 patients were randomly assigned to the online or in-person groups. The between-group difference in overall improvement in the EuroQol Visual Analogue Scale was -0.002 (95% confidence interval, -2.749 to 2.745), falling within an equivalence margin of ±8. The between-group difference in overall improvement in the 5-level EuroQol-5 Dimensions index was 0 (95% confidence interval, -0.003 to 0.003), falling within an equivalence margin of ±0.1. The between-group difference in overall improvement in Patient Health Questionnare-9 score was -0.33 (95% CI, -1.20 to 0.55), falling within an equivalence margin of ±3. LIMITATIONS Slightly different attrition rates between online and in-person arms (11% vs 9%), but no impact on outcomes. CONCLUSION The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in patients with psoriasis.
Collapse
Affiliation(s)
- Paulina M Young
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Alice Y Chen
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Adam R Ford
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michelle Y Cheng
- University of California Davis School of Medicine, Sacramento, California
| | - Christianne J Lane
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - April W Armstrong
- Keck School of Medicine of the University of Southern California, Los Angeles, California.
| |
Collapse
|
17
|
Roca S, Almenara M, Gilaberte Y, Gracia-Cazaña T, Morales Callaghan AM, Murciano D, García J, Alesanco Á. When Virtual Assistants Meet Teledermatology: Validation of a Virtual Assistant to Improve the Quality of Life of Psoriatic Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14527. [PMID: 36361408 PMCID: PMC9655501 DOI: 10.3390/ijerph192114527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Teledermatology has given dermatologists a tool to track patients' responses to therapy using images. Virtual assistants, the programs that interact with users through text or voice messages, could be used in teledermatology to enhance the interaction of the tool with the patients and healthcare professionals and the overall impact of the medication and quality of life of patients. As such, this work aimed to investigate the effectiveness of using a virtual assistant for teledermatology and its impact on the quality of life. We conducted surveys with the participants and measured the usability of the system with the System Usability Scale (SUS). A total of 34 participants (30 patients diagnosed with moderate-severe psoriasis and 4 healthcare professionals) were included in the study. The measurement of the improvement of quality of life was done by analyzing Psoriasis Quality of Life (PSOLIFE) and Dermatology Life Quality Index (DLQI) questionnaires. The results showed that, on average, the quality of life improved (from 63.8 to 64.8 for PSOLIFE (with a p-value of 0.66 and an effect size of 0.06) and 4.4 to 2.8 for DLQI (with a p-value of 0.04 and an effect size of 0.31)). Patients also used the virtual assistant to do 52 medical consultations. Moreover, the usability is above average, with a SUS score of 70.1. As supported by MMAS-8 results, adherence also improved slightly. Our work demonstrates the improvement of the quality of life with the use of a virtual assistant in teledermatology, which could be attributed to the sense of security or peace of mind the patients get as they can contact their dermatologists directly within the virtual assistant-integrated system.
Collapse
Affiliation(s)
- Surya Roca
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| | - Manuel Almenara
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragon, 50009 Zaragoza, Spain
| | - Yolanda Gilaberte
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragon, 50009 Zaragoza, Spain
| | - Tamara Gracia-Cazaña
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragon, 50009 Zaragoza, Spain
| | | | - Daniel Murciano
- Department of Dermatology, Miguel Servet University Hospital, IIS Aragon, 50009 Zaragoza, Spain
| | - José García
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| | - Álvaro Alesanco
- Aragón Institute of Engineering Research (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| |
Collapse
|
18
|
Trinh P, Yekrang K, Phung M, Pugliese S, Chang ALS, Bailey EE, Ko JM, Sarin KY. Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID-19 pandemic: A pilot programme. SKIN HEALTH AND DISEASE 2022; 2:e141. [PMID: 35941936 PMCID: PMC9349994 DOI: 10.1002/ski2.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/15/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Elderly patients in senior communities faced high barriers to care during the COVID-19 pandemic, including increased vulnerability to COVID-19, long quarantines for clinic visits, and difficulties with telemedicine adoption. OBJECTIVE To pilot a new model of dermatologic care to overcome barriers for senior living communities during the COVID-19 pandemic and assess patient satisfaction. METHODS From 16 November 2020 to 9 July 2021, this quality improvement programme combined in-residence full body imaging with real-time outlier lesion identification and virtual teledermatology. Residents from the Sequoias Portola Valley Senior Living Retirement Community (Portola Valley, California) voluntarily enroled in the Stanford Skin Scan Programme. Non-physician clinical staff with a recent negative COVID-19 test travelled on-site to obtain in-residence full body photographs using a mobile app-based system on an iPad called SkinIO that leverages deep learning to analyse patient images and suggest suspicious, outlier lesions for dermoscopic photos. A single dermatologist reviewed photographs with the patient and provided recommendations via a video visit. Objective measures included follow-up course and number of skin cancers detected. Subjective findings were obtained through patient experience surveys. RESULTS Twenty-seven individuals participated, three skin cancers were identified, with 11 individuals scheduled for a follow up in-person visit and four individuals starting home treatment. Overall, 88% of patients were satisfied with the Skin Scan programme, with 77% likely to recommend the programme to others. 92% of patients agreed that the Skin Scan photographs were representative of their skin. In the context of the COVID-19 pandemic, 100% of patients felt the process was safer or comparable to an in-person visit. Despite overall appreciation for the programme, 31% of patients reported that they would prefer to see dermatologist in-person after the pandemic. CONCLUSIONS This programme offers a framework for how a hybrid skin scan programme may provide high utility for individuals with barriers to accessing in-person clinics.
Collapse
Affiliation(s)
- Pavin Trinh
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Kiana Yekrang
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Michelle Phung
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Silvina Pugliese
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Anne Lynn S. Chang
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Elizabeth E. Bailey
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Justin M. Ko
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| | - Kavita Y. Sarin
- Department of DermatologyStanford University School of MedicineStanfordCaliforniaUSA
| |
Collapse
|
19
|
Update on the Management of Pediatric Psoriasis: An Italian Consensus. Dermatol Ther (Heidelb) 2022; 12:1753-1775. [PMID: 35776408 PMCID: PMC9247936 DOI: 10.1007/s13555-022-00758-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/08/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.
Collapse
|
20
|
A Pilot Study to Assess the Reliability of Digital Image-Based PASI Scores Across Patient Skin Tones and Provider Training Levels. Dermatol Ther (Heidelb) 2022; 12:1685-1695. [PMID: 35727498 PMCID: PMC9276898 DOI: 10.1007/s13555-022-00750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction The ability to perform psoriasis skin assessments remotely through digital image-based psoriasis area and severity index (DIB-PASI) would be a valuable tool for psoriasis clinical trials. An ideal teledermatological assessment would be robust across patients of diverse skin tones as well as across assessors of varying experience levels. In this pilot study, we evaluated the reliability of face-to-face (FTF) versus DIB-PASI scores determined by trained clinical assessors with a spectrum of experience and with patients of different skin tones. Methods Fourteen subjects of varying skin tones with moderate-to-severe plaque psoriasis were treated with adalimumab. In-person PASI assessments and digital photography were performed in the clinic at weeks 0, 12, and 24. Photographs were reviewed by four independent assessors to derive a digital image-based PASI score. The concordance of face-to-face PASI (FTF-PASI) and DIB-PASI were analyzed across patient and assessor factors. Results Overall concordance between FTF-PASI and DIB-PASI was high (ICC 0.82, p < 0.0001), with good agreement across individual assessors. When analyzed by PASI score component or body region, digital assessors also demonstrated good agreement with the FTF assessor. Similarly, DIB-PASI showed high concordance with FTF-PASI for patients with light skin tones and patients with medium-to-dark skin tones, and across clinical training levels. Conclusion Overall, PASI scores derived from digital images showed good agreement with those determined in person. Importantly, these remote assessments were reliable for both light and medium-to-dark skin tones, and robust to training level of the assessor. The findings from this pilot study lay the foundation for expanding teledermatology-based clinical trials for patients with psoriasis and enabling accurate, remote monitoring of disease severity and therapy response. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00750-w.
Collapse
|
21
|
Ruggiero A, Megna M, Fabbrocini G, Martora F. Video and telephone teledermatology visits during COVID-19 in comparison: patients' satisfaction, doubts, and concerns. Clin Exp Dermatol 2022; 47:1863-1864. [PMID: 35656801 PMCID: PMC9347843 DOI: 10.1111/ced.15286] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Angelo Ruggiero
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| |
Collapse
|
22
|
Rhon DI, Fritz JM, Kerns RD, McGeary DD, Coleman BC, Farrokhi S, Burgess DJ, Goertz CM, Taylor SL, Hoffmann T. TIDieR-telehealth: precision in reporting of telehealth interventions used in clinical trials - unique considerations for the Template for the Intervention Description and Replication (TIDieR) checklist. BMC Med Res Methodol 2022; 22:161. [PMID: 35655144 PMCID: PMC9161193 DOI: 10.1186/s12874-022-01640-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 05/20/2022] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Recent international health events have led to an increased proliferation of remotely delivered health interventions. Even with the pandemic seemingly coming under control, the experiences of the past year have fueled a growth in ideas and technology for increasing the scope of remote care delivery. Unfortunately, clinicians and health systems will have difficulty with the adoption and implementation of these interventions if ongoing and future clinical trials fail to report necessary details about execution, platforms, and infrastructure related to these interventions. The purpose was to develop guidance for reporting of telehealth interventions.
Methods
A working group from the US Pain Management Collaboratory developed guidance for complete reporting of telehealth interventions. The process went through 5-step process from conception to final checklist development with input for many stakeholders, to include all 11 primary investigators with trials in the Collaboratory.
Results
An extension focused on unique considerations relevant to telehealth interventions was developed for the Template for the Intervention Description and Replication (TIDieR) checklist.
Conclusion
The Telehealth Intervention guideline encourages use of the Template for the Intervention Description and Replication (TIDieR) checklist as a valuable tool (TIDieR-Telehealth) to improve the quality of research through a reporting guide of relevant interventions that will help maximize reproducibility and implementation.
Collapse
|
23
|
Mocharnuk J, Lockard T, Georgesen C, English JC. Inpatient Teledermatology: a Review. CURRENT DERMATOLOGY REPORTS 2022; 11:52-59. [PMID: 35402084 PMCID: PMC8976271 DOI: 10.1007/s13671-022-00360-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Purpose of Review Inpatient teledermatology is a rapidly growing field with significant potential to add value and streamline patient care. This review summarizes the current literature on inpatient teledermatology, primarily focusing on its diagnostic and clinical management utility as compared to live dermatologic evaluation. Recent Findings The COVID-19 pandemic has accelerated the adoption of inpatient teledermatology, which has been shown to be comparable to live hospitalist evaluation for triage, diagnosis, and management of hospitalized patients for a wide variety of conditions. Despite its comparative cost-effectiveness and recent changes in reimbursement practices, inpatient teledermatology still lacks sufficient reimbursement incentive for widespread implementation. Summary Inpatient teledermatology is an effective, efficient, accurate, and cost-effective means of managing the hospital burden of skin disease, especially in areas where access to dermatologic care is limited. It is essential that dermatologists and referring providers comprehend the use and potential pitfalls of inpatient teledermatology to effectively incorporate it into hospital practice.
Collapse
|
24
|
Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J Clin Med 2022; 11:jcm11061511. [PMID: 35329838 PMCID: PMC8950226 DOI: 10.3390/jcm11061511] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The most frequent inflammatory skin diseases are psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne. Their management is challenging for dermatologists since their relapsing chronic clinical course is associated with a great impact on quality of life. Nevertheless, the recent introduction of novel therapies, such as biological drugs and small molecules has been changing the history of these diseases. Methods: A systematic review of the scientific literature of case reports, case series, epidemiological studies, reviews, and systematic reviews regarding teledermatology and inflammatory skin disease. Studies were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Results: A total of 69 cases articles were included in the review. Conclusions: As we have shown in the review, several experiences of teledermatology for patients affected by inflammatory skin diseases have been demonstrated to increase due to clinical access to hospital and specialized health care services, allowing better access to specialized dermatology care for people living in remote areas, and saving costs and money with health care.
Collapse
|
25
|
|
26
|
Havelin A, Hampton P. Telemedicine and e-Health in the Management of Psoriasis: Improving Patient Outcomes – A Narrative Review. Psoriasis (Auckl) 2022; 12:15-24. [PMID: 35320971 PMCID: PMC8935082 DOI: 10.2147/ptt.s323471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
The role of technology in dermatology is expanding. Telemedicine and eHealth are increasingly being used by doctors and patients in the management of psoriasis. This is a narrative review of the literature relating to the use of digital technology in the management of psoriasis. We divided psoriasis e-health into three areas: mobile phone applications, teledermatology and artificial Intelligence (AI). Literature searches were conducted using the following databases: Pubmed, Google Scholar, Scopus, both app stores using App Annie platform. The following words were used in searches; psoriasis, dermatology, mobile phone application, application, app, smartphone, teledermatology, telemedicine, artificial intelligence, AI, machine learning in various combinations. We defined three key questions, one relating to each of the 3 areas. We then reviewed the relevant papers found in the searches and selected the papers of highest research quality and greatest relevance in order to answer the questions. In addition, for apps, operating systems for IOS and android devices were searched for apps containing the key word “psoriasis” in the title using the app analytic website www.appannie.com on 08/11/21. Research publications linked to these apps were reviewed.
Collapse
Affiliation(s)
- Alison Havelin
- Department of Dermatology, Newcastle Hospitals NHS Trust, Newcastle, UK
| | - Philip Hampton
- Department of Dermatology, Newcastle Hospitals NHS Trust, Newcastle, UK
- Correspondence: Philip Hampton, Email
| |
Collapse
|
27
|
Guo R, Hou M, Han Y, Feng XL. Access, charge and quality of tele-dermatology e-consults in China: A standardized patients study. Digit Health 2022; 8:20552076221140763. [PMID: 36465986 PMCID: PMC9716584 DOI: 10.1177/20552076221140763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE Direct-to-consumer telemedicine is rapidly changing the way that patients seek medical care. This study provided the first report on access, cost and quality of text- and image-based tele-dermatology e-consults, in China. METHODS We adopted the Standardized Patients approach to evaluate the services of tele-dermatology e-consults in two metropolitan cities, that is, Beijing and Hangzhou, in China. We measured quality from four dimensions: service process, diagnosis accuracy, prescription and treatment comprehensiveness, based on China's national clinical guidelines. We performed logistic regressions to investigate factors that were associated with high-quality care. RESULTS For 114 physicians eligible for inclusion, we succeeded in 87 (76%) validated visits. The median waiting time was 100 minutes (IQR 19-243 minutes) and the median length of consultation was 636 minutes (about 10 hours, IQR 188-1528 minutes). Per visit costs varied from $0 to $38, with a median of $8 (IQR 4-9). Among all, 15% of visits showed high quality in service process, 84% arrived in the correct diagnosis, 24% provided high-quality prescriptions and 71% provided comprehensive treatment. Providing images was associated with high quality in service process (OR 7.22, 95% CI 1.49-34.88). Visits in metropolitan Beijing and on non-work days had better prescription quality than that in metropolitan Hangzhou (OR 6.05, 95% CI 1.75-20.95) and that on workdays (OR 3.75, 95%CI 1.27-11.04), respectively. CONCLUSIONS Tele-dermatology e-consults seem to be easy to access and less expensive in China. However, great efforts are warranted to ensure that service processes and prescriptions adhere to clinical guidelines.
Collapse
Affiliation(s)
- Rui Guo
- School of Public Health, Capital Medical University, Beijing, China
| | - Mengchi Hou
- China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China
| | - Yangyang Han
- Beijing Chinese Medical Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
28
|
So H, Chow E, Cheng IT, Lau SL, Li TK, Szeto CC, Tam LS. Factors Associated With Use of Telemedicine for Follow-Up of SLE in the COVID-19 Outbreak. Front Med (Lausanne) 2021; 8:790652. [PMID: 34966764 PMCID: PMC8710609 DOI: 10.3389/fmed.2021.790652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic. Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared. Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income > USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up. Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.
Collapse
Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Evelyn Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sze-Lok Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tena K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| |
Collapse
|
29
|
Giovannini I, Bosch P, Dejaco C, De Marco G, McGonagle D, Quartuccio L, De Vita S, Errichetti E, Zabotti A. The Digital Way to Intercept Psoriatic Arthritis. Front Med (Lausanne) 2021; 8:792972. [PMID: 34888334 PMCID: PMC8650082 DOI: 10.3389/fmed.2021.792972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022] Open
Abstract
Psoriasis (PsO) and Psoriatic Arthritis (PsA) are chronic, immune-mediated diseases that share common etiopathogenetic pathways. Up to 30% of PsO patient may later develop PsA. In nearly 75% of cases, skin psoriatic lesions precede arthritic symptoms, typically 10 years prior to the onset of joint symptoms, while PsO diagnosis occurring after the onset of arthritis is described only in 15% of cases. Therefore, skin involvement offers to the rheumatologist a unique opportunity to study PsA in a very early phase, having a cohort of psoriatic “risk patients” that may develop the disease and may benefit from preventive treatment. Progression from PsO to PsA is often characterized by non-specific musculoskeletal symptoms, subclinical synovio-entheseal inflammation, and occasionally asymptomatic digital swelling such as painless toe dactylitis, that frequently go unnoticed, leading to diagnostic delay. The early diagnosis of PsA is crucial for initiating a treatment prior the development of significant and permanent joint damage. With the ongoing development of pharmacological treatments, early interception of PsA has become a priority, but many obstacles have been reported in daily routine. The introduction of digital technology in rheumatology may fill the gap in the physician-patient relationship, allowing more targeted monitoring of PsO patients. Digital technology includes telemedicine, virtual visits, electronic health record, wearable technology, mobile health, artificial intelligence, and machine learning. Overall, this digital revolution could lead to earlier PsA diagnosis, improved follow-up and disease control as well as maximizing the referral capacity of rheumatic centers.
Collapse
Affiliation(s)
- Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | | | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Enzo Errichetti
- Department of Medical and Biological Sciences, Institute of Dermatology, University of Udine, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| |
Collapse
|
30
|
Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
Collapse
Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
| |
Collapse
|
31
|
Montes de Oca Pedrosa A, Oakley A, Rogers J, Rangaitaha Epiha M. PASI vs PO-PASI: Patient-Oriented PASI (PO-PASI) is comparable to clinician score PASI. Australas J Dermatol 2021; 63:e67-e70. [PMID: 34755891 DOI: 10.1111/ajd.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/13/2021] [Accepted: 10/16/2021] [Indexed: 11/30/2022]
Abstract
This comparative observational study aimed to validate an online Patient-oriented Psoriasis Area and Severity Index (PO-PASI) by comparing it against the Psoriasis Area and Severity Index (PASI), of 97 adult participants with chronic plaque psoriasis. Pearson's correlation coefficient of 0.866 (P-value = 0.0001) showed a strong positive linear correlation, and interclass correlation coefficients [ICC scores = 0.864 [95% confidence intervals (CIs) (0.803 < ICC < 0.907)]] suggest an interrater reliability of 'good' to 'excellent' when comparing PO-PASI to the PASI score. Additionally, we compared PO-PASI and PASI with DLQI and demonstrated an overall stronger positive correlation between PO-PASI and DLQI when compared to PASI.
Collapse
Affiliation(s)
| | - Amanda Oakley
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.,Department of Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Jean Rogers
- Florida Atlantic University, Boca Raton, FL, USA
| | | |
Collapse
|
32
|
Skinner R, Breck A, Esposito D. An economic evaluation of teledermatology care delivery for chronic skin diseases. J Comp Eff Res 2021; 11:67-77. [PMID: 34747638 DOI: 10.2217/cer-2021-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Analyze the impact of nationwide implementation of teledermatological care for psoriasis. Methods: Develop a Markov model that estimates the impact of telehealth technology for treatment of moderate-to-severe psoriasis on health and healthcare expenditures compared with in-person clinical care. Results: Lower medical costs by US$1.5 billion and total social costs of US$4.3 billion over 5 years. Patients save more than 67 million hours in work absenteeism and travel time, valued at US$598 million. Employers save US$1.2 billion over 5 years due to decreased employee absenteeism. Conclusion: National implementation of telehealth for psoriasis care has the potential to substantially reduce both formal healthcare costs and informal costs for families and patients, while maintaining equivalent clinical outcomes as traditional in-person care.
Collapse
Affiliation(s)
| | - Andrew Breck
- Insight Policy Research, Inc., Arlington, VA 22209, USA
| | | |
Collapse
|
33
|
Abstract
Hintergrund In den letzten Jahren wurden mit dem E‑Health-Gesetz und der Lockerung des Fernbehandlungsverbotes die Rahmenbedingungen für die Telemedizin in Deutschland verbessert. Fragestellung Das Ziel dieses Beitrags ist es, eine Übersicht wichtiger Anwendungsgebiete der Teledermatologie darzustellen. Material und Methode Erstellt wurde eine narrative Übersichtsarbeit von nationalen und internationalen Studien und Projekten zum Einsatz der Teledermatologie für die Diagnosestellung, die Verlaufskontrolle, die Triage zwischen Haus- und Hautärzten sowie den Einsatz in Einrichtungen mit organisatorisch und/oder geografisch erschwertem Zugang zu fachmedizinischer Versorgung. Ergebnisse Diagnostische Anwendungen ermöglichen in einem Großteil der Fälle die teledermatologische Beurteilung bei hoher Konkordanz der Diagnose und Patientenzufriedenheit. In der Versorgung chronischer Patienten wurde in der Mehrzahl von Studien nachgewiesen, dass kein Unterschied in der Effektivität der Behandlung zwischen der Präsenz- und Fernbehandlung vorliegt und Patienten Anfahrtswege und Wartezeiten einsparen. Bei dermatologischen Fällen, die mithilfe der Teletriage evaluiert wurden, konnte ein Großteil beim Hausarzt verbleiben. Gleichzeitig wurden Patienten identifiziert, die schnellstmöglich beim Hautarzt vorstellig werden sollten. In besonderen Einrichtungen wie Justizvollzugsanstalten werden dermatologische Telekonsile erfolgreich eingesetzt. Diskussion Für die Nutzung der Teledermatologie in Deutschland liegen hinreichende Rahmenbedingungen und eine befriedigende Evidenz vor. Die Anwendungsbereiche sind detailliert in der S2k-Leitlinie der Teledermatologie abgebildet. Es besteht das Risiko, dass der Zugang zur Telemedizin für bestimmte Bevölkerungsgruppen erschwert sein könnte.
Collapse
|
34
|
Domogalla L, Beck A, Schulze-Hagen T, Herr R, Benecke J, Schmieder A. Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study. JMIR Mhealth Uhealth 2021; 9:e28149. [PMID: 34431478 PMCID: PMC8576562 DOI: 10.2196/28149] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/27/2021] [Accepted: 07/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background Psoriasis has a negative impact on patients’ physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk
Collapse
Affiliation(s)
- Lena Domogalla
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Alena Beck
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Theresa Schulze-Hagen
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Raphael Herr
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Johannes Benecke
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Astrid Schmieder
- Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.,Department of Dermatology, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
35
|
van de Kerkhof PCM. Future perspectives on care for patients with psoriasis. What did we learn during the COVID-19. J DERMATOL TREAT 2021; 32:477. [PMID: 34182877 DOI: 10.1080/09546634.2021.1945655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Peter C M van de Kerkhof
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| |
Collapse
|
36
|
Gisondi P, Bellinato F, Piaserico S, Di Leo S, Cazzaniga S, Naldi L. Preference for Telemedicine Versus In-Person Visit Among Patients with Psoriasis Receiving Biological Drugs. Dermatol Ther (Heidelb) 2021; 11:1333-1343. [PMID: 34173220 PMCID: PMC8232561 DOI: 10.1007/s13555-021-00555-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The use of telemedicine has significantly increased since the outbreak of the SARS-CoV-2 pandemic. In the dermatological setting, patients with stable plaque psoriasis on maintenance therapy with biological drugs may be suitable candidates for telemedicine, although their preference for telemedicine has not yet been investigated. The aim of this study was to investigate the preference for telemedicine versus in-person visit among patients with psoriasis receiving biological drugs and the reported reasons behind their preferences. Methods Consecutive adult patients with chronic plaque psoriasis in stable clinical remission (Psoriasis Area Severity Index [PASI] ≤ 3 for at least 12 months) receiving maintenance biological therapy answered a survey investigating whether they would choose telemedicine or in-person visit for the next scheduled visit and the reasons behind their preference. The survey was undertaken through a questionnaire that was developed according to a structured process. Results Of the 246 participants in the survey, 118 (48%) preferred telemedicine over an in-person visit for their next scheduled visit with a dermatologist. Multivariate logistic regression analysis revealed that previous experience with digital video-communication tools was a significant predictor for the preference for telemedicine (odds ratio [OR] 10.75; 95% confidence interval [CI] 3.61–32.03), while older age (< 60 years) was negatively associated with the preference for telemedicine (OR 0.30; 95% CI 0.10–0.90). The most common reasons (75%) for preferring telemedicine were saving time and safety in relation to the risk presented by the Sars-CoV-2 pandemic (38%). In contrast, 56% of the patients who preferred the in-person visit option declared that they were unable to use video-communication tools. Conclusion About half of the patients with stable psoriasis receiving biological drugs may be good candidates for telemedicine. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s13555-021-00555-3.
Collapse
Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Stefano Piaserico
- Section of Dermatology, Department of Medicine, University of Padua, Padua, Italy
| | - Sara Di Leo
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy.,Centro Studi GISED, Bergamo, Italy
| |
Collapse
|
37
|
Thompson L, Li E, Krasnow N, Chang M, Said J, Molina G, Polyakov N, Yoon J, Dee E, Huang K, Blum A, Kuchroo J, Hinton A, Reynolds K, Chen S. Effect of dermatological consultation on survival in patients with checkpoint inhibitor‐associated cutaneous toxicity. Br J Dermatol 2021; 185:627-635. [DOI: 10.1111/bjd.20074] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023]
Affiliation(s)
- L.L. Thompson
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - E.B. Li
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - N.A. Krasnow
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - M.S. Chang
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J.T. Said
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - G.E. Molina
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - N.J. Polyakov
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J. Yoon
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - E.C. Dee
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - K. Huang
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - A.E. Blum
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - J.R. Kuchroo
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - A.N. Hinton
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - K.L. Reynolds
- Department of Medicine Division of Hematology and Oncology Massachusetts General Hospital Cancer Center and Harvard Medical School Boston MA USA
| | - S.T. Chen
- Department of Dermatology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| |
Collapse
|
38
|
Trettin B, Danbjørg DB, Andersen F, Feldman S, Agerskov H. Development of an mHealth App for Patients With Psoriasis Undergoing Biological Treatment: Participatory Design Study. JMIR DERMATOLOGY 2021; 4:e26673. [PMID: 37632817 PMCID: PMC10501531 DOI: 10.2196/26673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/11/2021] [Accepted: 04/17/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Denmark, patients with psoriasis undergoing biological treatment have regular follow-ups, typically every 3 months. This may pose a challenge for patients who live far away from the hospital. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis undergoing biological treatment because the disease course can be properly monitored. Despite recent developments in mHealth, the full potential of teledermatology remains to be tapped by newer, more attractive forms of services focused on patients' needs. OBJECTIVE This study aims to design and develop an mHealth app to support the self-management of patients with psoriasis using a participatory design. METHODS Using participatory design, we conducted 1 future workshop, 4 mock-up workshops, and 1 prototype test with patients and health care professionals to co-design a prototype. The process was iterative to ensure that all stakeholders would provide input into the design and outcome; this approach enabled continuous revision of the prototype until an acceptable solution was agreed upon. Data were analyzed according to the steps-plan, act, observe, and reflect-in the methodology of participatory design. RESULTS Health care professionals and patients emphasized the importance of a more patient-centered approach, focusing on the communication and maintenance of relationships. Patients perceived consultations to be impersonal and repetitive and wanted the opportunity to contribute to the agenda while attending a consultation. Patients also stated they would prefer not to attend visits in person every 3 months. On the basis of these findings, we designed an mHealth app that could replace in-person visits and support patients at in-person visits. Video consultations, self-monitoring, and registration of patient-reported outcome data were embedded in the app. CONCLUSIONS Using participatory design facilitated mutual learning and democratic processes that gave end users a significant influence over the solution. Despite the advantages of using participatory design in developing mHealth solutions, organizational conditions may still represent a barrier to the optimization of solutions.
Collapse
Affiliation(s)
- Bettina Trettin
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Dorthe Boe Danbjørg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Flemming Andersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Private Hospital Molholm, Vejle, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Steven Feldman
- Center for Dermatology Research, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hanne Agerskov
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
39
|
Tognetti L, Fiorani D, Russo F, Lazzeri L, Trovato E, Flori ML, Moscarella E, Cinotti E, Rubegni P. Teledermatology in 2020: past, present and future perspectives. Ital J Dermatol Venerol 2021; 156:198-212. [PMID: 33960751 DOI: 10.23736/s2784-8671.21.06731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Born in 1995, teledermatology (TD) turns 25 years old today. Since then, TD evolved according to patients and physicians needs. The present review aimed to summarize all the efforts and experiences carried out in the field of TD and its subspecialties, the evolution and the future perspectives. A literature search was conducted in PubMed and Google Scholar. The state of the art of the "tele-dermo research" included TD and clinical trials, TD/TDS web platforms, TDS and artificial intelligence studies. Finally, the future perspective of TD/TDS in the era of social distancing was discussed. Using TD in specific situations adds several benefits including time-effectiveness of intervention and reduction in the waiting time for the first visit, reduced travel-costs, reduced sanitary costs, equalization of access from patient to specialistic consult. The communication technologies devices currently available can adequately support the growing needs of tele-assistance. A main limit is the current lack of a common clear European regulation for practicing TD, encompassing privacy issues and data management. The pandemic lockdown of 2020 has highlighted the importance of performing TD for all those patient, elderly and/or fragile, where the alternative would be no care at all. Many efforts are needed to develop efficient workflows and TD programs to facilitate the interplay among the different TD actors, along with practice guidelines or position statements.
Collapse
Affiliation(s)
- Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy -
| | - Diletta Fiorani
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Filomena Russo
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Laura Lazzeri
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Emanuele Trovato
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Maria L Flori
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Elvira Moscarella
- Unit of Dermatology, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
40
|
Affiliation(s)
- April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Indira Singh
- Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
41
|
Ammenwerth E, Neyer S, Hörbst A, Mueller G, Siebert U, Schnell-Inderst P. Adult patient access to electronic health records. Cochrane Database Syst Rev 2021; 2:CD012707. [PMID: 33634854 PMCID: PMC8871105 DOI: 10.1002/14651858.cd012707.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To support patient-centred care, healthcare organisations increasingly offer patients access to data stored in the institutional electronic health record (EHR). OBJECTIVES Primary objective 1. To assess the effects of providing adult patients with access to electronic health records (EHRs) alone or with additional functionalities on a range of patient, patient-provider, and health resource consumption outcomes, including patient knowledge and understanding, patient empowerment, patient adherence, patient satisfaction with care, adverse events, health-related quality of life, health-related outcomes, psychosocial health outcomes, health resource consumption, and patient-provider communication. Secondary objective 1. To assess whether effects of providing adult patients with EHR access alone versus EHR access with additional functionalities differ among patient groups according to age, educational level, or different status of disease (chronic or acute). SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and Scopus in June 2017 and in April 2020. SELECTION CRITERIA Randomised controlled trials and cluster-randomised trials of EHR access with or without additional functionalities for adults with any medical condition. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 10 studies with 78 to 4500 participants and follow-up from 3 to 24 months. Nine studies assessed the effects of EHR with additional functionalities, each addressing a subset of outcomes sought by this review. Five studies focused on patients with diabetes mellitus, four on patients with specific diseases, and one on all patients. All studies compared EHR access alone or with additional functionalities plus usual care versus usual care only. No studies assessing the effects of EHR access alone versus EHR access with additional functionalities were identified. Interventions required a variety of data within the EHR, such as patient history, problem list, medication, allergies, and lab results. In addition to EHR access, eight studies allowed patients to share self-documented data, seven offered individualised disease management functions, seven offered educational disease-related information, six supported secure communication, and one offered preventive reminders. Only two studies were at low or unclear risk of bias across domains. Meta-analysis could not be performed, as participants, interventions, and outcomes were too heterogeneous, and most studies presented results based on different adjustment methods or variables. The quality of evidence was rated as low or very low across outcomes. Overall differences between intervention and control groups, if any, were small. The relevance of any small effects remains unclear for most outcomes because in most cases, trial authors did not define a minimal clinically important difference. Overall, results suggest that the effects of EHR access alone and with additional functionalities are mostly uncertain when compared with usual care. Patient knowledge and understanding: very low-quality evidence is available from one study, so we are uncertain about effects of the intervention on patient knowledge about diabetes and blood glucose testing. Patient empowerment: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient empowerment measures. Patient adherence: low-quality evidence from two studies suggests that the intervention may slightly improve adherence to the process of monitoring risk factors and preventive services. Effects on medication adherence are conflicting in two studies; this may or may not improve to a clinically relevant degree. Patient satisfaction with care: low-quality evidence from three studies suggests that the intervention may have little or no effect on patient satisfaction, with conflicting results. Adverse events: two small studies reported on mortality; one of these also reported on serious and other adverse events, but sample sizes were too small for small differences to be detected. Therefore, low-quality evidence suggests that the intervention may have little to no effect on mortality and other adverse events. Health-related quality of life: only very low-quality evidence from one study is available. We are uncertain whether the intervention improves disease-specific quality of life of patients with asthma. Health-related outcomes: low-quality evidence from eight studies suggests that the intervention may have little to no effect on asthma control, glycosylated haemoglobin (HbA1c) levels, blood pressure, low-density lipoprotein or total cholesterol levels, body mass index or weight, or 10-year Framingham risk scores. Low-quality evidence from one study suggests that the composite scores of risk factors for diabetes mellitus may improve slightly with the intervention, but there is uncertainty about effects on ophthalmic medications or intraocular pressure. Psychosocial health outcomes: no study investigated psychosocial health outcomes in a more than anecdotal way. Health resource consumption: low-quality evidence for adult patients in three studies suggests that there may be little to no effect of the intervention on different measures of healthcare use. Patient-provider communication: very low-quality evidence is available from a single small study, and we are uncertain whether the intervention improves communication measures, such as the number of messages sent. AUTHORS' CONCLUSIONS The effects of EHR access with additional functionalities in comparison with usual care for the most part are uncertain. Only adherence to the process of monitoring risk factors and providing preventive services as well as a composite score of risk factors for diabetes mellitus may improve slightly with EHR access with additional functionalities. Due to inconsistent terminology in this area, our search may have missed relevant studies. As the overall quality of evidence is very low to low, future research is likely to change these results. Further trials should investigate the impact of EHR access in a broader range of countries and clinical settings, including more patients over a longer period of follow-up, as this may increase the likelihood of detecting effects of the intervention, should these exist. More studies should focus on assessing outcomes such as patient empowerment and behavioural outcomes, rather than concentrating on health-related outcomes alone. Future studies should distinguish between effects of EHR access only and effects of additional functionalities, and investigate the impact of mobile EHR tools. Future studies should include information on usage patterns, and consider the potential for widening health inequalities with implementation of EHR access. A taxonomy for EHR access and additional functionalities should be developed to promote consistency and comparability of outcome measures, and facilitate future reviews by better enabling cross-study comparisons.
Collapse
Affiliation(s)
- Elske Ammenwerth
- Department of Biomedical Informatics and Mechatronics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Stefanie Neyer
- Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Alexander Hörbst
- Department of Biomedical Informatics and Mechatronics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Petra Schnell-Inderst
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| |
Collapse
|
42
|
Merz V, Ferro A, Piras EM, Zanutto A, Caffo O, Messina C. Electronic Medical Record-Assisted Telephone Follow-Up of Breast Cancer Survivors During the COVID-19 Pandemic: A Single Institution Experience. JCO Oncol Pract 2020; 17:e44-e52. [PMID: 33351674 DOI: 10.1200/op.20.00643] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 outbreak rapidly became a public health emergency and led to radical changes in patient management. From the start of the pandemic, we used electronic medical record-assisted telephone follow-up (E-TFU) of cancer survivors (CS) to minimize hospital exposure. The aim of this prospective study was to assess how breast cancer survivors (bCSs) perceived E-TFU. MATERIALS AND METHODS A 15-item survey was e-mailed to bCSs who had been managed with E-TFU. The responses were measured using Likert-like scales and were correlated with the main characteristics of the bCS using Pearson's test. RESULTS One hundred thirty-seven of 343 bCSs (40%) completed the survey between March 9 and June 2, 2020. Their median age was 59 years. Although 80.3% of bCSs were satisfied with E-TFU, only 43.8% would like to have E-TFU in the future. A low educational level was correlated with higher COVID-19-related anxiety (P = .025). An older age (P = .002) and a low educational level (P < .0001) were correlated with the need to be accompanied to reach the hospital. A personal history of second cancer was inversely correlated with understanding medical advice (P = .015) and the expectation of feeling relief after a follow-up visit (P = .0027). Furthermore, pandemic phase II was correlated with satisfaction with E-TFU (P = .010). CONCLUSION E-TFU was an important means of avoiding hospital contacts during the COVID-19 pandemic, and the majority of bCSs in the survey were satisfied with this procedure. Further studies are needed to investigate the implementation of telemedicine even outside an emergency situation.
Collapse
Affiliation(s)
- Valeria Merz
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Antonella Ferro
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Enrico Maria Piras
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
| | - Alberto Zanutto
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
| | - Orazio Caffo
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| | - Carlo Messina
- Department of Medical Oncology, Santa Chiara Hospital, Trento, Italy
| |
Collapse
|
43
|
Beer J, Hadeler E, Calume A, Gitlow H, Nouri K. Teledermatology: current indications and considerations for future use. Arch Dermatol Res 2020; 313:11-15. [PMID: 33074356 PMCID: PMC7570421 DOI: 10.1007/s00403-020-02145-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 02/05/2023]
Abstract
Telemedicine is one of the most consequential technologies in modern healthcare. In certain situations, it allows for the delivery of care with high quality and minimal difficulty. This is particularly true in dermatology, in which many dermatological conditions can be treated remotely. The burden on dermatology patients has been greatly reduced for certain pathologies due to telemedicine. Health care providers also achieve improved job satisfaction following the convenience of meeting their patients. This paper details select dermatological conditions, and subsequently divides them into those treatable by telemedicine appointments, and those requiring face to face appointments.
Collapse
Affiliation(s)
- Jacob Beer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Edward Hadeler
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Alejo Calume
- Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Howard Gitlow
- Miami Herbert Business School, University of Miami, Miami, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| |
Collapse
|
44
|
National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1. J Am Acad Dermatol 2020; 83:1704-1716. [PMID: 32891785 PMCID: PMC7471802 DOI: 10.1016/j.jaad.2020.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 02/08/2023]
Abstract
Objective To provide guidance about management of psoriatic disease during the coronavirus disease 2019 (COVID-19) pandemic. Study design A task force (TF) of 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care was convened. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation (NPF) staff. Clinical questions relevant to the psoriatic disease community were informed by questions received by the NPF. A Delphi process was conducted. Results The TF approved 22 guidance statements. The average of the votes was within the category of agreement for all statements. All guidance statements proposed were recommended, 9 with high consensus and 13 with moderate consensus. Limitations The evidence behind many guidance statements is limited in quality. Conclusion These statements provide guidance for the management of patients with psoriatic disease on topics ranging from how the disease and its treatments impact COVID-19 risk and outcome, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 and what they should do if they develop COVID-19. The guidance is intended to be a living document that will be updated by the TF as data emerge.
Collapse
|
45
|
Gonçalves-Bradley DC, J Maria AR, Ricci-Cabello I, Villanueva G, Fønhus MS, Glenton C, Lewin S, Henschke N, Buckley BS, Mehl GL, Tamrat T, Shepperd S. Mobile technologies to support healthcare provider to healthcare provider communication and management of care. Cochrane Database Syst Rev 2020; 8:CD012927. [PMID: 32813281 PMCID: PMC7437392 DOI: 10.1002/14651858.cd012927.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The widespread use of mobile technologies can potentially expand the use of telemedicine approaches to facilitate communication between healthcare providers, this might increase access to specialist advice and improve patient health outcomes. OBJECTIVES To assess the effects of mobile technologies versus usual care for supporting communication and consultations between healthcare providers on healthcare providers' performance, acceptability and satisfaction, healthcare use, patient health outcomes, acceptability and satisfaction, costs, and technical difficulties. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and three other databases from 1 January 2000 to 22 July 2019. We searched clinical trials registries, checked references of relevant systematic reviews and included studies, and contacted topic experts. SELECTION CRITERIA Randomised trials comparing mobile technologies to support healthcare provider to healthcare provider communication and consultations compared with usual care. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included 19 trials (5766 participants when reported), most were conducted in high-income countries. The most frequently used mobile technology was a mobile phone, often accompanied by training if it was used to transfer digital images. Trials recruited participants with different conditions, and interventions varied in delivery, components, and frequency of contact. We judged most trials to have high risk of performance bias, and approximately half had a high risk of detection, attrition, and reporting biases. Two studies reported data on technical problems, reporting few difficulties. Mobile technologies used by primary care providers to consult with hospital specialists We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference to primary care providers following guidelines for people with chronic kidney disease (CKD; 1 trial, 47 general practices, 3004 participants); - probably reduce the time between presentation and management of individuals with skin conditions, people with symptoms requiring an ultrasound, or being referred for an appointment with a specialist after attending primary care (4 trials, 656 participants); - may reduce referrals and clinic visits among people with some skin conditions, and increase the likelihood of receiving retinopathy screening among people with diabetes, or an ultrasound in those referred with symptoms (9 trials, 4810 participants when reported); - probably make little or no difference to patient-reported quality of life and health-related quality of life (2 trials, 622 participants) or to clinician-assessed clinical recovery (2 trials, 769 participants) among individuals with skin conditions; - may make little or no difference to healthcare provider (2 trials, 378 participants) or participant acceptability and satisfaction (4 trials, 972 participants) when primary care providers consult with dermatologists; - may make little or no difference for total or expected costs per participant for adults with some skin conditions or CKD (6 trials, 5423 participants). Mobile technologies used by emergency physicians to consult with hospital specialists about people attending the emergency department We assessed the certainty of evidence for this group of trials as moderate. Mobile technologies: - probably slightly reduce the consultation time between emergency physicians and hospital specialists (median difference -12 minutes, 95% CI -19 to -7; 1 trial, 345 participants); - probably reduce participants' length of stay in the emergency department by a few minutes (median difference -30 minutes, 95% CI -37 to -25; 1 trial, 345 participants). We did not identify trials that reported on providers' adherence, participants' health status and well-being, healthcare provider and participant acceptability and satisfaction, or costs. Mobile technologies used by community health workers or home-care workers to consult with clinic staff We assessed the certainty of evidence for this group of trials as moderate to low. Mobile technologies: - probably make little or no difference in the number of outpatient clinic and community nurse consultations for participants with diabetes or older individuals treated with home enteral nutrition (2 trials, 370 participants) or hospitalisation of older individuals treated with home enteral nutrition (1 trial, 188 participants); - may lead to little or no difference in mortality among people living with HIV (RR 0.82, 95% CI 0.55 to 1.22) or diabetes (RR 0.94, 95% CI 0.28 to 3.12) (2 trials, 1152 participants); - may make little or no difference to participants' disease activity or health-related quality of life in participants with rheumatoid arthritis (1 trial, 85 participants); - probably make little or no difference for participant acceptability and satisfaction for participants with diabetes and participants with rheumatoid arthritis (2 trials, 178 participants). We did not identify any trials that reported on providers' adherence, time between presentation and management, healthcare provider acceptability and satisfaction, or costs. AUTHORS' CONCLUSIONS Our confidence in the effect estimates is limited. Interventions including a mobile technology component to support healthcare provider to healthcare provider communication and management of care may reduce the time between presentation and management of the health condition when primary care providers or emergency physicians use them to consult with specialists, and may increase the likelihood of receiving a clinical examination among participants with diabetes and those who required an ultrasound. They may decrease the number of people attending primary care who are referred to secondary or tertiary care in some conditions, such as some skin conditions and CKD. There was little evidence of effects on participants' health status and well-being, satisfaction, or costs.
Collapse
Affiliation(s)
| | - Ana Rita J Maria
- Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Brian S Buckley
- Department of Surgery, University of the Philippines, Manila, Philippines
| | - Garrett L Mehl
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Tigest Tamrat
- Department of Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
46
|
Lopez-Villegas A, Bautista-Mesa RJ, Baena-Lopez MA, Alvarez-Moreno ML, Montoro-Robles JE, Vega-Ramirez FA, Ordoñez-Naranjo I, Hernandez-Montoya CJ, Leal-Costa C, Peiro S. Economic impact and cost savings of teledermatology units compared to conventional monitoring at hospitals in southern Spain. J Telemed Telecare 2020; 28:436-444. [PMID: 32722989 DOI: 10.1177/1357633x20942044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Asynchronous teledermatology (TD) has undergone exponential growth in the past decade, allowing better diagnosis. Moreover, it saves both cost and time and reduces the number of visits involving travel and opportunity cost of time spent on visits to the hospital. The present study performed a cost-saving analysis of TD units and assessed whether they offered a cheaper alternative to conventional monitoring (CM) in hospitals from the perspective of public health-care systems (PHS) and patients. METHODS This study was a retrospective assessment of 7030 patients. A cost-saving analysis comparing TD units to CM for patients at the Hospital de Poniente was performed over a period of one year. The TD network covered the Hospital de Poniente reference area (Spain) linked to 37 primary care (PC) centres that belonged to the Poniente Health District of Almeria. RESULTS We observed a significant cost saving for TD units compared to participants in the conventional follow-up group. From the perspective of a PHS, there was a cost saving of 31.68% in the TD group (€18.59 TD vs. €27.20 CM) during the follow-up period. The number of CM visits to the hospital reduced by 38.14%. From the patients' perspective, the costs were lower, and the cost saving was 73.53% (€5.45 TD vs. €20.58 CM). DISCUSSION The cost-saving analysis showed that the TD units appeared to be significantly cheaper compared to CM.
Collapse
Affiliation(s)
- Antonio Lopez-Villegas
- Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Hospital de Poniente, Spain
| | | | | | | | - Jesus E Montoro-Robles
- Poniente Primary Care District, Servicio Andaluz de Salud, Hum-498 Research Group, Spain
| | | | - Isabel Ordoñez-Naranjo
- Poniente Primary Care District, Servicio Andaluz de Salud, Hum-498 Research Group, Spain
| | | | | | - Salvador Peiro
- Health Services Research Unit, FISABIO-Public Health, Spain
| |
Collapse
|
47
|
Mostafa PIN, Hegazy AA. Dermatological consultations in the COVID-19 era: is teledermatology the key to social distancing? An Egyptian experience. J DERMATOL TREAT 2020; 33:910-915. [PMID: 32602763 DOI: 10.1080/09546634.2020.1789046] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has received marked attention globally. A worldwide call for social distancing occurred. Although the reduction of face-to-face consultation is required in order to reduce the risk of infection, dermatological services must be maintained in action and 'teledermatology' should be the solution.Materials & methods: We introduce a cross sectional observational study, demonstrating the patients' behavior regarding dermatological consultations in Cairo, Egypt in both private and Public practice. Synchronous (live interaction via What's app and Zoom) and asynchronous (What's app, emails) teledermatology models were used. After the end of the teleconsultation, patients were asked to fill a questionnaire adapted from the Telehealth Usability Questionnaire (TUQ). RESULTS There was an overall satisfaction and future use score among the interviewed patients that received Teledermatology services of 91.0%, a usefulness score of 93.7%, interface and interaction quality scores of 85.9% and 87.0%, ease and use learnability score of 87.8% and reliability score of 86.7%. CONCLUSION Teledermatology was efficient in triaging and treatment, hence, decreasing risk of COVID-19 exposure for the physician, the patient and the paramedical personel in heavily populated third world countries. Legislation is needed to sanction physician compensation for tele dermatology where this does not exist.
Collapse
Affiliation(s)
- Pakinam I N Mostafa
- Dermatology department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Amira Aly Hegazy
- Public Health department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
48
|
Brunasso AMG, Massone C. Teledermatologic monitoring for chronic cutaneous autoimmune diseases with smartworking during COVID-19 emergency in a tertiary center in Italy. Dermatol Ther 2020; 33:e13495. [PMID: 32458588 PMCID: PMC7267078 DOI: 10.1111/dth.13695] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/24/2020] [Indexed: 02/02/2023]
Abstract
Because of the coronavirus disease 2019 (COVID‐19) emergency, on March 9, 2020 Italy went in lock‐down imposing the closure of non‐urgent outpatient clinics devoted to care of chronic, severe, inflammatory skin diseases that require periodic follow‐up. In this emergency situation, due to the lack of a teledermatology platform and in order not to leave our vulnerable high‐need patients without proper follow‐up, we started a teledermatologic service in smartworking using phone calls and emails. The total number of patients scheduled was 195; in 12 cases, we were not able to talk to the patients. Remote monitoring was performed in 183 patients (126 moderate to severe psoriasis, 10 severe acne, 11 severe atopic dermatitis, 11 hidradenitis suppurativa, 9 blistering autoimmune diseases, and 16 other autoimmune skin diseases). During remote‐visits, several interventions were conducted: triage for COVID‐19 suspected symptoms, email check of clinical pictures and of laboratory examinations, advices for topical and systemic therapy continuation or discontinuation/switch and reschedule of next appointment. Only five patients required personal office visit (2.7%), reducing consistently the number of face‐to face visits. Our real‐life experience shows that remote monitoring was effective in preventing unnecessary worsening of severe chronic skin diseases and poor outcomes due to withdrawal of current therapy.
Collapse
Affiliation(s)
| | - Cesare Massone
- Department of Dermatology, Galliera Hospital, Genoa, Italy
| |
Collapse
|
49
|
Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol 2020; 83:299-307. [PMID: 32035106 DOI: 10.1016/j.jaad.2020.01.065] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.
Collapse
Affiliation(s)
- Robin H Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Stavert
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | |
Collapse
|
50
|
Georgesen C, Karim SA, Liu R, Moorhead A, Falo LD, English JC. Inpatient eDermatology (Teledermatology) Can Help Meet the Demand for Inpatient Skin Disease. Telemed J E Health 2019; 26:872-878. [PMID: 31663822 DOI: 10.1089/tmj.2019.0147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Currently, the number of inpatient dermatology providers cannot meet the overall burden of inpatient skin disease in the United States. Introduction: We seek to determine whether inpatient eDermatology can meet the need for inpatient skin disease in hospitals without access to a dermatology hospitalist. Methods: This retrospective cohort study reviewed inpatient eDermatology consults at the University of Pittsburgh eDermatology Consult Service between July 1, 2014 and June 30, 2018. This included a diverse group of 1,320 patients admitted to 10 different community hospitals. Study data were reviewed for demographics, diagnostic impressions, time to discharge, and diagnostic discordance between referring and consultant physicians. Results: Forty percent of inpatient eDermatology consults were admitted with a primary dermatologic diagnosis. Referring diagnosis most commonly was rash not otherwise specified. eDermatology consulting impressions, conversely, were specific and varied. Ninety-one percent of patients received a consultant impression by the end of day, or within 8 hours. Overall, 89.3% of patients with a referring diagnosis of "cellulitis" were given a different diagnosis by the consultant. Discussion: Although this study lacked concordance data to compare the Inpatient eDermatologist with a live Inpatient Dermatologist, overall, eDermatology consultants were able to provide rapid consult recommendations that aided patient management. Conclusions: Inpatient eDermatology appears to be an effective medium to provide dermatologic care to patients at hospitals without a dermatology presence. This delivery of health care can help prevent misdiagnosis, unnecessary costs, and inappropriate systemic therapies.
Collapse
Affiliation(s)
- Corey Georgesen
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sabrina A Karim
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rebecca Liu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Autumn Moorhead
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Louis D Falo
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,McGowan Institute for Regenerative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Joseph C English
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| |
Collapse
|