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Chernyshov PV, Finlay AY, Tomas-Aragones L, Tognetti L, Moscarella E, Pasquali P, Manolache L, Pustisek N, Svensson A, Marron SE, Bewley A, Salavastru C, Suru A, Koumaki D, Linder D, Abeni D, Augustin M, Blome C, Salek SS, Evers AWM, Poot F, Sampogna F, Szepietowski JС. Quality of life measurement in teledermatology. Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Teledermatology. J Eur Acad Dermatol Venereol 2024; 38:254-264. [PMID: 37877648 DOI: 10.1111/jdv.19570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Abstract
Many events, including the COVID-19 pandemic, have accelerated the implementation of teledermatology pathways within dermatology departments and across healthcare organizations. Quality of Life (QoL) assessment in dermatology is also a rapidly developing field with a gradual shift from theory to practice. The purpose of this paper organized jointly by the European Academy of Dermatology and Venereology (EADV) Task Force (TF) on QoL and patient-oriented outcomes and the EADV TF on teledermatology is to present current knowledge about QoL assessment during the use of teledermatology approaches, including data on health-related (HR) QoL instruments used in teledermatology, comparison of influence of different treatment methods on HRQoL after face-to-face and teledermatology consultations and to make practical recommendations concerning the assessment of QoL in teledermatology. The EADV TFs made the following position statements: HRQoL assessment may be an important part in most of teledermatology activities; HRQoL assessment may be easily and effectively performed during teledermatology consultations. It is especially important to monitor HRQoL of patients with chronic skin diseases during lockdowns or in areas where it is difficult to reach a hospital for face-to-face consultation; regular assessment of HRQoL of patients with skin diseases during teledermatology consultations may help to monitor therapy efficacy and visualize individual patient's needs; we recommend the use of the DLQI in teledermatology, including the use of the DLQI app which is available in seven languages; it is important to develop apps for dermatology-specific HRQoL instruments for use in children (for example the CDLQI and InToDermQoL) and for disease-specific instruments.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - A Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - E Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Pasquali
- Dermatology Department, Pius Hospital de Valls, Tarragona, Spain
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - N Pustisek
- Children's Hospital Zagreb, Zagreb, Croatia
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - S E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - A Bewley
- Whipps Cross University Hospital, London, UK
- The Royal London Hospital, London, UK
| | - C Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A Suru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - D Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Crete, Greece
| | - D Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Austria
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - A W M Evers
- Institute of Psychology, Health, Medical, and Neuropsychology unit, Leiden University, Leiden, The Netherlands
| | - F Poot
- Department of Dermatology, University Hospital Erasme, Brussels, Belgium
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
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Peracca SB, Lachica O, Lamkin RP, Jackson GL, Mohr DC, King HA, Whited JD, Fonseca AS, Morris IJ, Gifford AL, Weinstock MA, Oh DH. Implementation of Direct-to-Patient Mobile Teledermatology in VA. J Gen Intern Med 2024; 39:97-105. [PMID: 38252250 PMCID: PMC10937882 DOI: 10.1007/s11606-023-08480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. OBJECTIVE We evaluated Department of Veterans Affairs' (VA's) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. DESIGN /PARTICIPANTS/APPROACH Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app's implementation using qualitative and quantitative data consisting of encounter data from VA's corporate data warehouse; app usage from VA's Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. KEY RESULTS Implementation policies and practices included VA's vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. CONCLUSIONS Considerable heterogeneity existed in implementing mobile teledermatology, despite VA's common mission, integrated healthcare system, and stakeholders' broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. CLINICAL TRIALS REGISTRATION NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Olevie Lachica
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - Allene S Fonseca
- Department of Dermatology, Wayne State University, 18101 Oakwood Boulevard #402, Dearborn, MI, 48124, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
| | - Martin A Weinstock
- Department of Dermatology and Epidemiology, Brown University, 593 Eddy Street, Providence, RI, 02903, USA
- Center for Dermatoepidemiology, Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Dennis H Oh
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA.
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Nazi KM, Newton T, Armstrong CM. Unleashing the Potential for Patient-Generated Health Data (PGHD). J Gen Intern Med 2024; 39:9-13. [PMID: 38252246 PMCID: PMC10937868 DOI: 10.1007/s11606-023-08461-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 01/23/2024]
Abstract
Patient-generated health data (PGHD) is data created, captured, or recorded by patients in between healthcare appointments, and is an important supplement to data generated during periodic clinical encounters. PGHD has potential to improve diagnosis and management of chronic conditions, improve health outcomes, and facilitate more "connected health" between patients and their care teams. Electronic PGHD is rapidly accelerating due to the proliferation of consumer health technologies, remote patient monitoring systems, and personal health platforms. Despite this tremendous growth in PGHD and anticipated benefits, broadscale use of PGHD has been challenging to implement with significant gaps in current knowledge about how PGHD can best be employed in the service of high-quality, patient-centered care. While the role of PGHD in patient self-management continues to grow organically, we need a deeper understanding of how data collection and sharing translate into actionable information that supports shared decision-making and informs clinical care in real-world settings. This, in turn, will foster both clinical adoption and patient engagement with PGHD. We propose an agenda for PGHD-related research in the Veterans Health Administration that emphasizes this clinical value to enhance our understanding of its potential and limitations in supporting shared decision-making and informing clinical care.
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Affiliation(s)
- Kim M Nazi
- Trilogy Federal, LLC, Arlington, VA, USA.
- KMN Consulting Services, LTD, Coxsackie, NY, USA.
- Trilogy Federal, LLC, 44 Mountain View Drive, Coxsackie, NY, 12051, USA.
| | - Terry Newton
- Office of Connected Care, US Department of Veterans Affairs, Washington, DC, USA
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Li Y, Pulminskas A, Collins O, de la Feld S, Yeung H. Patient and Clinician Satisfaction in Teledermatology: Key Factors for Successful Implementation. Curr Dermatol Rep 2023; 12:161-168. [PMID: 38495517 PMCID: PMC10939000 DOI: 10.1007/s13671-023-00404-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 03/19/2024]
Abstract
Purpose of review Teledermatology has emerged as a promising solution for remote dermatologic care, especially during COVID-19 pandemic. It improves access to care through information and communication technologies. This paper explores patient and clinician satisfaction in teledermatology. Recent findings Patient satisfaction encompasses various aspects, including future willingness, the quality of care, technical quality, and access to care. Clinician satisfaction is influenced by quality of care, implementation, technical aspects, clinician-patient rapport, and financial considerations. It is important to evaluate patient and clinician satisfaction in different teledermatology models, including store-and-forward, live interactive, and hybrid interactive approaches. Summary By evaluating satisfaction within different teledermatology models and addressing the factors that impact satisfaction, teledermatology can ensure high-quality care and promote positive outcomes. With proper implementation and ongoing evaluation, teledermatology has the potential to become a widely accepted and valuable component of dermatologic care, offering enhanced access to specialized services.
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Affiliation(s)
- Yiwen Li
- Emory University School of Medicine, Atlanta, GA
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Anna Pulminskas
- Emory University School of Medicine, Atlanta, GA
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Olivia Collins
- Clinical Resource Hub, VA Veterans Integrated Service Network 7, Decatur, GA
| | - Salma de la Feld
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
- Clinical Resource Hub, VA Veterans Integrated Service Network 7, Decatur, GA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
- Clinical Resource Hub, VA Veterans Integrated Service Network 7, Decatur, GA
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Abstract
Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, "Community Health Services"[Mesh]) AND "Dermatology"[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels - general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.
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Affiliation(s)
- Neelakandhan Asokan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
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Iqbal MP, Newman B, Ellis LA, Mears S, Harrison R. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. Patient Educ Couns 2023; 115:107922. [PMID: 37542823 DOI: 10.1016/j.pec.2023.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.
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Affiliation(s)
- Maha Pervaz Iqbal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Mears
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Ringwald K, Arnold A, Haase H, Jünger M, Lutze S. [Telemedical aftercare of patients with skin diseases]. Dermatologie (Heidelb) 2022; 73:853-858. [PMID: 36127464 DOI: 10.1007/s00105-022-05057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Improved technologies, an increased need for medical healthcare as well as the shortage of specialist personnel lead to a growing importance of telemedical applications. Dermatology is especially suitable for telemedical applications because of the visual appearance of skin diseases. This can contribute to optimizing the care and aftercare of patients with skin diseases. OBJECTIVE An analysis of patient satisfaction with teledermatological aftercare at the University Hospital Greifswald using the teledermatological application Mobil Skin® (Infokom, Neubrandenburg, Germany) was carried out. Factors that influence patient satisfaction and the suitability of the teledermatological aftercare for different skin diseases were also analyzed. MATERIAL AND METHODS The evaluation of standardized questionnaires, analysis of demographic data of the patient collective and analysis of usage data concerning the teledermatological system Mobil Skin® were carried out. RESULTS A total of 91 out of 118 telemedically treated patients participated in the survey. The majority of the patients reported a high degree of satisfaction with the teledermatological aftercare. Patient satisfaction was independent of where the patients lived (minor center or middle center/main center). Patient satisfaction correlated with the frequency of use and the number of answers received through the teledermatological system. The aftercare with the teledermatological system Mobil Skin® was suitable for all diagnosis groups surveyed. Both older and younger patients as well as children benefited from this kind of aftercare.
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Affiliation(s)
- K Ringwald
- Dermatologie und Venerologie, der Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
| | - A Arnold
- Dermatologie und Venerologie, der Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
| | - H Haase
- Dermatologie und Venerologie, der Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
| | - M Jünger
- Dermatologie und Venerologie, der Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland.
| | - S Lutze
- Dermatologie und Venerologie, der Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Str., 17475, Greifswald, Deutschland
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Wu D, Lu X, Nakamura M, Sekhon S, Jeon C, Bhutani T, Liao W. 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. [PMID: 35727498 DOI: 10.1007/s13555-022-00750-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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von Stuelpnagel CC, Petersen J, Augustin M, Sommer R. [Dermatological care of elderly people with psoriasis before and after entering a nursing home : A qualitative analysis from the perspective of medical providers]. Hautarzt 2022; 73:627-633. [PMID: 35482046 PMCID: PMC9047578 DOI: 10.1007/s00105-022-04989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
Hintergrund Demografische Veränderungen bewirken einen steilen Anstieg der Anzahl der über 65-Jährigen. Damit verbunden ist die Zunahme der Anzahl pflegebedürftiger, multimorbid Erkrankter. National wie auch international gibt es keine Informationen insbesondere zur Versorgung von Psoriasiserkrankten im Setting Pflegeheim und zur Frage, wie diese durch den Eintritt in ein Pflegeheim beeinflusst wird. Fragestellung Ziel war es, anhand von Interviews bzw. Fokusgruppen die Ergebnisse vorausgehender Routinedatenanalysen zur Versorgung Psoriasiserkrankter in Pflegeheimen mit medizinischen Versorgern (Dermatologen, Allgemeinmediziner, Pflegedienstleitungen und Pflegekräfte) zu diskutieren, Schwierigkeiten der Versorgung aufzudecken und abschließend Handlungsempfehlungen für eine zukunftsfähige gerontodermatologische Versorgung abzuleiten. Material und Methoden Durchgeführt wurden qualitative Leitfaden-gestützte Interviews und Fokusgruppen mit Dermatologen (n = 5), Allgemeinmedizinern (n = 7), Pflegekräften (n = 7) und Pflegedienstleitungen (n = 2). Die Daten wurden inhaltsanalytisch ausgewertet. Ergebnisse Die Auswertung ergab insgesamt 344 Aussagen, die insgesamt 14 Hauptkategorien zugeordnet werden konnten. Die Ergebnisse zeigen, dass für die Versorgungsqualität von Menschen mit Hautkrankheiten, insbesondere Psoriasis, in Pflegeinrichtungen ein Verbesserungsbedarf besteht. Dieser zeigt sich sowohl auf ärztlicher als auch auf pflegerischer Ebene. Laut der Versorger (N = 21) kann dies insbesondere durch eine verstärkte digitale Versorgung, dermatologische Schulungen für Hausärzte und Pflegefachkräfte sowie engere Kooperationen zwischen den einzelnen Disziplinen adressiert werden. Schlussfolgerung Digitale Pflegekonsile, aber auch eine spezifische Leitlinie zur „Haut des alternden Menschen“ können von Nutzen sein, um die dermatologische Versorgungssituation im Pflegeheim zu verbessern und somit das Wohlbefinden der Betroffenen zu steigern.
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Affiliation(s)
- C C von Stuelpnagel
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - J Petersen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - R Sommer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
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11
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Ploderer B, Rezaei Aghdam A, Burns K. Patient-Generated Health Photos and Videos Across Health and Well-being Contexts: Scoping Review. J Med Internet Res 2022; 24:e28867. [PMID: 35412458 PMCID: PMC9044143 DOI: 10.2196/28867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Patient-generated health data are increasingly used to record health and well-being concerns and engage patients in clinical care. Patient-generated photographs and videos are accessible and meaningful to patients, making them especially relevant during the current COVID-19 pandemic. However, a systematic review of photos and videos used by patients across different areas of health and well-being is lacking. Objective This review aims to synthesize the existing literature on the health and well-being contexts in which patient-generated photos and videos are used, the value gained by patients and health professionals, and the challenges experienced. Methods Guided by a framework for scoping reviews, we searched eight health databases (CINAHL, Cochrane Library, Embase, PsycINFO, PubMed, MEDLINE, Scopus, and Web of Science) and one computing database (ACM), returning a total of 28,567 studies. After removing duplicates and screening based on the predefined inclusion criteria, we identified 110 relevant articles. Data were charted and articles were analyzed following an iterative thematic approach with the assistance of NVivo software (version 12; QSR International). Results Patient-generated photos and videos are used across a wide range of health care services (39/110, 35.5% articles), for example, to diagnose skin lesions, assess dietary intake, and reflect on personal experiences during therapy. In addition, patients use them to self-manage health and well-being concerns (33/110, 30%) and to share personal health experiences via social media (36/110, 32.7%). Photos and videos create significant value for health care (59/110, 53.6%), where images support diagnosis, explanation, and treatment (functional value). They also provide value directly to patients through enhanced self-determination (39/110, 35.4%), social (33/110, 30%), and emotional support (21/110, 19.1%). However, several challenges emerge when patients create, share, and examine photos and videos, such as limited accessibility (16/110, 14.5%), incomplete image sets (23/110, 20.9%), and misinformation through photos and videos shared on social media (17/110, 15.5%). Conclusions This review shows that photos and videos engage patients in meaningful ways across different health care activities (eg, diagnosis, treatment, and self-care) for various health conditions. Although photos and videos require effort to capture and involve challenges when patients want to use them in health care, they also engage and empower patients, generating unique value. This review highlights areas for future research and strategies for addressing these challenges.
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Affiliation(s)
- Bernd Ploderer
- School of Computer Science, Queensland University of Technology, Brisbane, Australia
| | - Atae Rezaei Aghdam
- School of Information Systems, Queensland University of Technology, Brisbane, Australia
| | - Kara Burns
- Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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12
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Marasca C, Annunziata MC, Camela E, Di Guida A, Fornaro L, Megna M, Napolitano M, Patruno C, Potestio L, Fabbrocini G. Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J Clin Med 2022; 11:1511. [PMID: 35329838 DOI: 10.3390/jcm11061511] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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13
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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14
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Augustin M, Djamei V, Elsner P, Gass S, Hofmann-Wellenhof R, Kaminski K, Kirsten N, Nast A, Navarini-Meury A, Otten M, Salzer B, von Kiedrowski R, Zink A, Strömer K. S2k-Guideline for Teledermatology. J Dtsch Dermatol Ges 2021. [PMID: 34932269 DOI: 10.1111/ddg.14615] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vahid Djamei
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Steffen Gass
- Dermatological Practice Günzburg, Günzburg, Germany
| | | | | | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Nast
- Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Navarini-Meury
- Department of Dermatology, Center for Skin Tumours, University Hospital Basel, Basel, Switzerland
| | - Marina Otten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Bernd Salzer
- Skin and Laser Center Heilbronn, Heilbronn, Germany
| | | | - Alexander Zink
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
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15
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Trettin B, Danbjørg DB, Andersen F, Feldman S, Agerskov H. An mHealth App to Support Patients With Psoriasis in Relation to Follow-up Consultations: Qualitative Study. JMIR Dermatol 2021; 4:e28882. [PMID: 37632803 PMCID: PMC10501526 DOI: 10.2196/28882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Teledermatology has the potential to help deliver health care by transforming the relationship between patients and health care professionals (HCPs), shifting the power of consultation so that patients can become more informed, assertive, and involved in their care. Mobile health (mHealth) is a promising and reliable tool for the long-term management of patients with psoriasis on systemic treatment. In an attempt to facilitate a more patient-centered approach in clinical practice, we designed and developed an mHealth solution to support patients with self-management and empowerment. OBJECTIVE The aim of this study is to explore the experiences and perceptions of patients and health care professionals of using an mHealth solution that was developed using a participatory design approach. METHODS This was an exploratory qualitative study. Data were collected through semistructured interviews with patients and focus group interviews with HCPs. RESULTS All participants found it easy to use the mHealth solution, and the patients found it convenient. Patients' reflexivity was improved because they could prepare ahead of consultations. Video consultations provided patients with a degree of freedom in their everyday lives, with not having to attend in-person visits. Among the HCPs, there were concerns regarding their medical responsibilities, as they could not assess the patients' skin as they used to. The mHealth solution required new workflows and procedures that were not part of the existing consultation routines. CONCLUSIONS The mHealth solution can strengthen the relationship between HCPs and patients and facilitate patients to become more active in their care. Alignment and structure in relation to the selection of eligible patient candidates for being offered the mHealth solution could reduce social health inequalities. In addition, video consultations changed HCPs' work practice, necessitating new types of skills to communicate with patients.
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Affiliation(s)
- Bettina Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
- Faculty of Health Science, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Dorthe Boe Danbjørg
- Faculty of Health Science, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Flemming Andersen
- Faculty of Health Science, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
- Private Hospital Molholm, Vejle, Denmark
| | - Steven Feldman
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Hanne Agerskov
- Faculty of Health Science, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
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16
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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 Dermatol 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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17
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Kelleher SA, Winger JG, Fisher HM, Miller SN, Reed SD, Thorn BE, Spring B, Samsa GP, Majestic CM, Shelby RA, Sutton LM, Keefe FJ, Somers TJ. Behavioral cancer pain intervention using videoconferencing and a mobile application for medically underserved patients: Rationale, design, and methods of a prospective multisite randomized controlled trial. Contemp Clin Trials 2021; 102:106287. [PMID: 33497833 DOI: 10.1016/j.cct.2021.106287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women with breast cancer in medically underserved areas are particularly vulnerable to persistent pain and disability. Behavioral pain interventions reduce pain and improve outcomes. Cancer patients in medically underserved areas receive limited adjunctive cancer care, as many lack access to pain therapists trained in behavioral interventions, face travel barriers to regional medical centers, and may have low literacy and limited resources. mHealth technologies have the potential to decrease barriers but must be carefully adapted for, and efficacy-tested with, medically underserved patients. We developed an mHealth behavioral pain coping skills training intervention (mPCST-Community). We now utilize a multisite randomized controlled trial to: 1) test the extent mPCST-Community reduces breast cancer patients' pain severity (primary outcome), pain interference, fatigue, physical disability, and psychological distress; 2) examine potential mediators of intervention effects; and 3) evaluate the intervention's cost and cost-effectiveness. METHODS/DESIGN Breast cancer patients (N = 180) will be randomized to mPCST-Community or an attention control. mPCST-Community's four-session protocol will be delivered via videoconferencing at an underserved community clinic by a remote pain therapist at a major medical center. Videoconference sessions will be supplemented with a mobile application. Participants will complete self-report measures at baseline, post-intervention, and 3- and 6-month follow-ups. CONCLUSIONS mPCST-Community has the potential to reduce pain and disability, and decrease barriers for cancer patients in medically underserved areas. This is one of the first trials to test an mHealth behavioral cancer pain intervention developed specifically for medically underserved communities. If successful, it could lead to widespread implementation and decreased health disparities.
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Affiliation(s)
- Sarah A Kelleher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Hannah M Fisher
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Shannon N Miller
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Shelby D Reed
- Population Health Sciences, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Beverly E Thorn
- The Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory P Samsa
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Catherine M Majestic
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
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18
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Trettin B, Feldman S, Andersen F, Danbjørg DB, Agerskov H. Improving management of psoriasis patients receiving biological treatment: A qualitative approach. Nurs Open 2021; 8:1283-1291. [PMID: 33385301 PMCID: PMC8046082 DOI: 10.1002/nop2.745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 01/10/2023] Open
Abstract
Aim To investigate psoriasis patients’ and healthcare professionals’ experiences and perspectives of follow‐up consultations. Design A qualitative study with a phenomenological‐hermeneutic approach. Method Participant observations of consultations and semi‐structured interviews were conducted with patients receiving biological treatment, together with two focus groups with healthcare professionals, from June 2018–January 2019. Data were analysed using a qualitative structured approach based on Paul Ricoeur's philosophy of interpretation. Results Consultations had a strong biomedical and corrective approach focusing on lifestyle behaviour change, measurements and permanent routines. Healthcare professionals felt the need for enhanced competencies providing lifestyle behaviour change support and the possibility of providing patients more specific strategies. They were faced with a dilemma between lacking the right skills and having a professional duty. The frequent follow‐up visits did not fit in with the patients’ everyday lives.
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Affiliation(s)
- Bettina Trettin
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Flemming Andersen
- Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.,Private Hospital Molholm, Vejle, Denmark
| | - Dorthe B Danbjørg
- Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Hanne Agerskov
- Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Nephrology, Odense University Hospital, Odense, Denmark
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19
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Al Rajeh AM, Aldabayan YS, Aldhahir A, Pickett E, Quaderi S, Alqahtani JS, Mandal S, Lipman MC, Hurst JR. Once Daily Versus Overnight and Symptom Versus Physiological Monitoring to Detect Exacerbations of Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e17597. [PMID: 33185560 PMCID: PMC7695523 DOI: 10.2196/17597] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/17/2020] [Accepted: 05/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Earlier detection of chronic obstructive pulmonary disease (COPD) exacerbations may facilitate more rapid treatment with reduced risk of hospitalization. Changes in pulse oximetry may permit early detection of exacerbations. We hypothesized that overnight pulse oximetry would be superior to once-daily monitoring for the early detection of exacerbations. Objective This study aims to evaluate whether measuring changes in heart rate and oxygen saturation overnight is superior to once-daily monitoring of both parameters and to assess symptom changes in facilitating earlier detection of COPD exacerbations. Methods A total of 83 patients with COPD were randomized to once-daily or overnight pulse oximetry. Both groups completed the COPD assessment test questionnaire daily. The baseline mean and SD for each pulse oximetry variable were calculated from 14 days of stable monitoring. Changes in exacerbation were expressed as Z scores from this baseline. Results The mean age of the patients was 70.6 (SD 8.1) years, 52% (43/83) were female, and the mean FEV1 was 53.0% (SD 18.5%) predicted. Of the 83 patients, 27 experienced an exacerbation. Symptoms were significantly elevated above baseline from 5 days before to 12 days after treatment initiation. Day-to-day variation in pulse oximetry during the stable state was significantly less in the overnight group than in the once-daily group. There were greater relative changes at exacerbation in heart rate than oxygen saturation. An overnight composite score of change in heart rate and oxygen saturation changed significantly from 7 days before initiation of treatment for exacerbation and had a positive predictive value for exacerbation of 91.2%. However, this was not statistically better than examining changes in symptoms alone. Conclusions Overnight pulse oximetry permits earlier detection of COPD exacerbations compared with once-daily monitoring. Monitoring physiological variables was not superior to monitoring symptoms, and the latter would be a simpler approach, except where there is a need for objective verification of exacerbations. Trial Registration ClinicalTrials.gov NCT03003702; https://clinicaltrials.gov/ct2/show/NCT03003702
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Affiliation(s)
- Ahmed M Al Rajeh
- Department of respiratory care, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | - Abdulelah Aldhahir
- UCL Respiratory, University College London, London, United Kingdom.,Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Elisha Pickett
- Department of respiratory medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Shumonta Quaderi
- UCL Respiratory, University College London, London, United Kingdom
| | - Jaber S Alqahtani
- UCL Respiratory, University College London, London, United Kingdom.,Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Swapna Mandal
- UCL Respiratory, University College London, London, United Kingdom.,Department of respiratory medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Marc Ci Lipman
- UCL Respiratory, University College London, London, United Kingdom.,Department of respiratory medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - John R Hurst
- UCL Respiratory, University College London, London, United Kingdom.,Department of respiratory medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Ridard E, Secember H, Carvalho-lallement P, Schuers M. Indicateurs en télédermatologie : une revue de la littérature. Ann Dermatol Venereol 2020; 147:602-17. [DOI: 10.1016/j.annder.2020.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/25/2019] [Accepted: 01/31/2020] [Indexed: 11/24/2022]
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Hadeler E, Gitlow H, Nouri K. Definitions, survey methods, and findings of patient satisfaction studies in teledermatology: a systematic review. Arch Dermatol Res 2020; 313:205-215. [PMID: 32725501 PMCID: PMC7385477 DOI: 10.1007/s00403-020-02110-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023]
Abstract
Remote consultations likely will grow in importance if the COVID-19 pandemic continues. This review analyzes which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys and concluded patients respond to the different modalities of teledermatology. Using PubMed and Cochrane databases, we reviewed studies from April 5th, 2010 to April 5th, 2020 that included the search terms patient satisfaction and teledermatology. All studies that included patient satisfaction as an outcome were included, but studies not published in English were excluded. We examined domains of satisfaction, survey method, study characteristics (including patient population, country, age, study design and evidence score), findings and statistical comparisons. We thoroughly reviewed 23 studies. Definitions of satisfaction varied, but all concluded patients were satisfied with the live-interactive and store-and-forward modalities. The studies reveal that store-and-forward is appropriate for clinicians with established patients who require regular follow-up. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring, and post-procedural follow-up. Only four studies conducted statistical analyses. One of those studies compared patient preference for each modality of teledermatology with face-to-face dermatology. While this study reported high satisfaction with each mode of teledermatology, patients still preferred face-to-face. Favorable responses to remote diagnostic capabilities suggest that these offerings improve preference for teledermatology. With only one study evaluating preference between each modality and face-to-face dermatology, more studies should address the discrepancy. Surveys that cover all domains of satisfaction may improve assessments and identify where gaps in preference exist.
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Affiliation(s)
- Edward Hadeler
- Miller School of Medicine Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Howard Gitlow
- Herbert Business School, University of Miami, Coral Gables, FL, USA
| | - Keyvan Nouri
- Miller School of Medicine Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
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Burns K, McBride CA, Patel B, FitzGerald G, Mathews S, Drennan J. Creating Consumer-Generated Health Data: Interviews and a Pilot Trial Exploring How and Why Patients Engage. J Med Internet Res 2019; 21:e12367. [PMID: 31199312 PMCID: PMC6598415 DOI: 10.2196/12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/24/2019] [Accepted: 03/24/2019] [Indexed: 01/19/2023] Open
Abstract
Background Consumer-generated health data (CGHD) are any clinically relevant data collected by patients or their carers (consumers) that may improve health care outcomes. Like patient experience measures, these data reflect the consumer perspective and is part of a patient-centric agenda. The use of CGHD is believed to enhance diagnosis, patient engagement, and thus foster an improved therapeutic partnership with health care providers. Objective The aim of this study was to further identify how these data were used by consumers and how it influences engagement via a validated framework. In addition, carer data has not been explored for the purpose of engagement. Methods Study 1 used interviews with CGHD-experienced patients, carers, and doctors to understand attitudes about data collection and use, developing an ontological framework. Study 2 was a pilot trial with carers (parents) of children undergoing laparoscopic appendectomy. For 10 days carers generated and emailed surgical site photographs to a tertiary children’s hospital. Subsequently, carers were interviewed about the engagement framework. In total, 60 interviews were analyzed using theme and content analysis. Results This study validates a framework anchored in engagement literature, which categorizes CGHD engagement outcomes into 4 domains: physiological, cognitive, emotional, and behavioral. CGHD use is complex, interconnected, and can be organized into 10 themes within these 4 domains. Conclusions CGHD can instigate an ecosystem of engagement and provide clinicians with an enhanced therapeutic relationship through an extended view into the patient’s world. In addition to clinical diagnosis and efficient use of health care resources, data offer another tool to manage consumers service experience, especially the emotions associated with the health care journey. Collection and use of data increases consumers sense of reassurance, improves communication with providers, and promotes greater personal responsibility, indicating an empowering consumer process. Finally, it can also improve confidence and satisfaction in the service.
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Affiliation(s)
- Kara Burns
- QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Craig A McBride
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Bhaveshkumar Patel
- Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Gerard FitzGerald
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia
| | - Shane Mathews
- QUT Business School, Queensland University of Technology, Brisbane, Australia
| | - Judy Drennan
- QUT Business School, Queensland University of Technology, Brisbane, Australia
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Janda M, Horsham C, Koh U, Gillespie N, Vagenas D, Loescher LJ, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Peter Soyer H. Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer. Digit Health 2019; 5:2055207619828225. [PMID: 30792879 PMCID: PMC6376520 DOI: 10.1177/2055207619828225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the study is to evaluate healthcare practitioners’ views on and
satisfaction with (i) digital image acquisition and storage and (ii)
store-and-forward teledermoscopy services for the diagnosis of skin cancer
in their clinical practice. Methods An online survey was conducted among 59 healthcare practitioners (GPs
(n=17), dermatologists (n=22),
dermatology registrars (n=18), a dermatology research
fellow (n=1) and a plastic surgeon (n=1))
to assess usability of digital image acquisition and storage for when the
imaging process is conducted by the healthcare practitioners themselves, or
by their patients. The study identifies the enablers and barriers of this
emerging mode of medical practice. A thematic analysis was used to extract
key themes from open-ended responses, which involved identifying themes and
patterns within and across participants. Results Thirty-four healthcare practitioners (58%) had previously used a mobile
dermatoscope within their practice. Participants most appreciated its use in
their practice for lesion monitoring (59%) and record keeping (39%).
Challenges reported were the increased time to support the additional
workload (45%), technical issues (33%) and cost of equipment (27%).
Practitioners were unsure (36%) or did not advocate teledermoscopy for
direct-to-consumer use (41%). Only 23% supported the use of
direct-to-consumer teledermoscopy. Conclusion While most practitioners are receptive to mobile teledermoscopy, there was
less support for patient-initiated use, whereby the patient controls the
imaging process. As technology improves rapidly it is important to evaluate
practitioners’ acceptance and satisfaction of evolving telehealth services,
moving forward with models of practice where healthcare practitioners and
other healthcare providers will feel comfortable engaging in telehealth
services.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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Dorfman CS, Kelleher SA, Winger JG, Shelby RA, Thorn BE, Sutton LM, Keefe FJ, Gandhi V, Manohar P, Somers TJ. Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities. J Psychosoc Oncol 2018; 37:335-349. [PMID: 30585762 PMCID: PMC10183752 DOI: 10.1080/07347332.2018.1479327] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to refine and test a mobile-health behavioral cancer pain coping skills training protocol for women with breast cancer and pain from medically underserved areas. Three focus groups (Phase 1) were used to refine the initial protocol. A single-arm pilot trial (Phase 2) was conducted to assess feasibility, acceptability, and changes in outcomes. The intervention was delivered at a community-based clinic via videoconferencing technology. Participants were women (N = 19 for Phase 1 and N = 20 for Phase 2) with breast cancer and pain in medically underserved areas. Major themes from focus groups were used to refine the intervention. The refined intervention demonstrated feasibility and acceptability. Participants reported significant improvement in pain severity, pain interference, and self-efficacy for pain management. Our intervention is feasible, acceptable, and likely to lead to improvement in pain-related outcomes for breast cancer patients in medically underserved areas. Implications for Psychosocial Oncology Practice Breast cancer patients being treated in medically underserved areas have a dearth of exposure to behavioral interventions that may improve their ability to manage pain. Evidence from this single-arm pilot trial suggests that our mobile-health behavioral cancer pain coping skills training protocol is acceptable and feasible in this vulnerable population. Appropriately adapted mobile-health technologies may provide an avenue to reach underserved patients and implement behavioral interventions to improve pain management.
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Affiliation(s)
| | - Sarah A Kelleher
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Joseph G Winger
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Rebecca A Shelby
- a Duke University Medical Center , Durham , North Carolina , USA
| | | | - Linda M Sutton
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Francis J Keefe
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Vicky Gandhi
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Preethi Manohar
- a Duke University Medical Center , Durham , North Carolina , USA
| | - Tamara J Somers
- a Duke University Medical Center , Durham , North Carolina , USA
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Wang YC, Ganzorig B, Wu CC, Iqbal U, Khan HAA, Hsieh WS, Jian WS, Li YCJ. Patient satisfaction with dermatology teleconsultation by using MedX. Comput Methods Programs Biomed 2018; 167:37-42. [PMID: 30501858 DOI: 10.1016/j.cmpb.2018.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/02/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The development of telecommunication has strongly affected comprehensive scientific disciplines, including medical sciences. OBJECTIVE This study aims to assess the patient satisfaction of the teleconsultation system used for the consultation of dermatological follow-up care. METHODS The study was performed cross sectional patient satisfaction survey method conducted between February and April 2017 to determine patient satisfaction using MedX teleconsultation system. The patient sample of the current study was recruited from cosmetic laser clinic, Wanfang and Taipei Medical University hospital. The study was performed on 32 patient (n = 32) participants. All of them were at least university graduate. Consultants and patients were handled using the Android-based MedX mobile application, which is available through an application for Google Android cellular telephones. Its application consists of a demographic information, structured step-by-step questionnaire, essential medical information about each patient, and digital images of skin lesions. RESULTS 28 patients completed the questionnaire. The mean ± SD age of the patients was 27.25 ± 4.039 years; 78.6% were women. The study shows that respondents have reported a high level (85.8%) of mean overall satisfaction for the teleconsultation service. The usability of the system has highest satisfaction rate of 90.5% among the other subscales especially in terms of data transfer and data displayed. Responses of the patient satisfaction questionnaire were analyzed by age and gender, no statistically significant difference between the variables was found. CONCLUSION Patients have shown high satisfaction with teleconsultation service and it is well accepted in the management of cosmetic dermatology service. In the future, MedX application can be integrated into other instant messaging applications such as Line, thus allowing doctors and patients to easily communicate with each other.
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Affiliation(s)
- Yao-Chin Wang
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; Department of Emergency, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Bilegjin Ganzorig
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chieh-Chen Wu
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Usman Iqbal
- Masters Program in Global Health and Development Department, PhD Program in Global Health and Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Department of Public Health and Community Medicine, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Hafash-Arshed-Ali Khan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
| | - Wan-Shan Hsieh
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Shan Jian
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan.
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; School of Health Care Administration, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan.
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Augustin M, Wimmer J, Biedermann T, Blaga R, Dierks C, Djamei V, Elmer A, Elsner P, Enk A, Gass S, Henningsen M, Hofman-Wellenhof R, von Kiedrowski R, Kunz HD, Liebram C, Navarini A, Otten M, Reusch M, Schüller C, Zink A, Strömer K. Praxis der Teledermatologie. J Dtsch Dermatol Ges 2018; 16 Suppl 5:6-57. [DOI: 10.1111/ddg.13512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Johannes Wimmer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Hautklinik Campus Biederstein; Technische Universität München, München
| | - Rolf Blaga
- Psoriasis Selbsthilfe Arbeitsgemeinschaft e. V.; Berlin
| | | | | | - Arno Elmer
- Hochschule für Ökonomie und Management Berlin, Berlin
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena, Jena
| | - Alexander Enk
- Hautklinik; Universitätsklinikum Heidelberg, Heidelberg
| | | | - Maike Henningsen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | | | | | | | - Marina Otten
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | - Alexander Zink
- Dermatologischen Universitätsklinik; Technischen Universität München, München
| | - Klaus Strömer
- Gemeinschaftspraxis für Dermatologie und Allergologie; Mönchengladbach
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28
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Florek AG, Wang CJ, Armstrong AW. Treatment preferences and treatment satisfaction among psoriasis patients: a systematic review. Arch Dermatol Res 2018; 310:271-319. [DOI: 10.1007/s00403-018-1808-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/21/2017] [Accepted: 01/12/2018] [Indexed: 12/01/2022]
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Marchell R, Locatis C, Burgess G, Maisiak R, Liu WL, Ackerman M. Patient and Provider Satisfaction with Teledermatology. Telemed J E Health 2017; 23:684-690. [PMID: 28375822 PMCID: PMC5564023 DOI: 10.1089/tmj.2016.0192] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is little research comparing dermatologist and patient satisfaction with in-person, store-and-forward, and live interactive examinations. OBJECTIVE To compare satisfaction with in-person examinations to store-and-forward and live interactive consultations having two types of video. METHODS A controlled study was conducted where patients referred for dermatology consultations were examined in-person, by video, and by store-and-forward methods. Video changed between compressed and uncompressed on alternate clinics. Patients and dermatologists rated encounters after each examination. Dermatologists doing store-and-forward evaluations rated the quality of information provided. After experiencing all methods patients ranked their preferences. Dermatologists ranked their preferences at the end of the study. RESULTS In-person examinations were preferred by both patients and dermatologists. Overall, satisfaction with teledermatology was still high. Patients were evenly divided in preferring store-and-forward workups or live interactive video. Dermatologists were also divided on store-and-forward and uncompressed video, but tended toward the latter. Compressed video was the least preferred method among dermatologists. LIMITATIONS Dermatology residents took store-and-forward photos and their quality was likely superior to those normally taken in practice. CONCLUSIONS Patients and dermatologists prefer in-person examinations and diverge on preferring store-and-forward and live interactive when video is not compressed. The amount of video compression that can be applied without noticeable image degradation is a question for future research.
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Affiliation(s)
- Richard Marchell
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Craig Locatis
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Gene Burgess
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | | | - Wei-Li Liu
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Michael Ackerman
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
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Trettel A, Eissing L, Augustin M. Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review. J Eur Acad Dermatol Venereol 2017; 32:215-224. [PMID: 28516492 DOI: 10.1111/jdv.14341] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/29/2017] [Indexed: 01/28/2023]
Abstract
Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.
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Affiliation(s)
- A Trettel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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31
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Mounessa JS, Chapman S, Braunberger T, Qin R, Lipoff JB, Dellavalle RP, Dunnick CA. A systematic review of satisfaction with teledermatology. J Telemed Telecare 2017; 24:263-270. [PMID: 28350281 DOI: 10.1177/1357633x17696587] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The two most commonly used modalities of teledermatology (TD) are store-and-forward (SF) and live-interactive (LI) TD. Existing studies have not compared these tools with respect to patient and provider satisfaction. Objective To systematically review all published studies of patient and provider satisfaction with SF and LI TD. Methods PubMed, EMBASE, and Cochrane databases were systematically searched for studies on provider or patient satisfaction with SF or LI TD between January 2000 and June 2016. Results Forty eligible studies were identified: 32 with SF TD, 10 with LI TD, and 2 evaluating both. With SF TD, 96% of studies assessing patient satisfaction and 82% of studies assessing provider satisfaction demonstrated satisfaction ( n = 24 and 17, respectively). With LI TD, 89% of studies assessing patient satisfaction and all studies assessing provider satisfaction revealed satisfaction (n = 9 and 6, respectively). Conclusion Patients and providers are satisfied with both SF and LI TD. Studies assessing satisfaction with LI have not been conducted in recent years, and have only been conducted in limited geographic patient populations. Further research assessing satisfaction with TD will help address any dissatisfaction with its uses and allow for increased support and funding of future programmes.
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Affiliation(s)
- Jessica S Mounessa
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie Chapman
- 2 Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Rosie Qin
- 4 Duke University School of Medicine, Durham, NC, USA
| | - Jules B Lipoff
- 5 Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert P Dellavalle
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,6 Dermatology Service, Eastern Colorado Health Care System, US; Department of Veteran Affairs, Denver, CO, USA.,7 Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Cory A Dunnick
- 1 Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,6 Dermatology Service, Eastern Colorado Health Care System, US; Department of Veteran Affairs, Denver, CO, USA
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33
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McKoy K, Antoniotti NM, Armstrong A, Bashshur R, Bernard J, Bernstein D, Burdick A, Edison K, Goldyne M, Kovarik C, Krupinski EA, Kvedar J, Larkey J, Lee-Keltner I, Lipoff JB, Oh DH, Pak H, Seraly MP, Siegel D, Tejasvi T, Whited J. Practice Guidelines for Teledermatology. Telemed J E Health 2016; 22:981-990. [PMID: 27690203 DOI: 10.1089/tmj.2016.0137] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.
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Affiliation(s)
- Karen McKoy
- 1 Department of Dermatology, Lahey Hospital and Medical Center , Burlington, Massachusetts
- 2 Harvard Medical School , Boston, Massachusetts
| | | | - April Armstrong
- 4 Southern California Clinical and Translational Science Institute (SC CTSI) , Los Angeles, California
- 5 Department of Dermatology, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Rashid Bashshur
- 6 University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Anne Burdick
- 9 University of Miami Miller School of Medicine , Miami, Florida
| | - Karen Edison
- 10 Department of Dermatology, University of Missouri School of Medicine , Colombia , Missouri
- 11 Missouri Telehealth Network, University of Missouri School of Medicine , Colombia , Missouri
- 12 Center for Health Policy, University of Missouri School of Medicine , Colombia , Missouri
| | - Mark Goldyne
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Carrie Kovarik
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Elizabeth A Krupinski
- 15 Department of Radiology and Imaging Sciences, Emory University , Atlanta, Georgia
| | - Joseph Kvedar
- 17 Connected Health, Partners HealthCare , Boston, Massachusetts
| | - Jim Larkey
- 19 Canfield Scientific , Parsippany, New Jersey
| | - Ivy Lee-Keltner
- 21 Department of Dermatology, University of California Los Angeles-Olive View , Los Angeles, California
| | - Jules B Lipoff
- 14 Department of Dermatology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Dennis H Oh
- 13 Department of Dermatology, University of California San Francisco , San Francisco, California
- 16 Dermatology Service, San Francisco VA Healthcare System , San Francisco, California
| | - Hon Pak
- 18 Department of Dermatology, The George Washington University , Washington, DC
| | - Mark P Seraly
- 25 Department of Dermatology, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Daniel Siegel
- 20 State University of New York Health Sciences Center at Brooklyn , Brooklyn, New York
| | - Trilokraj Tejasvi
- 22 Department of Dermatology, University of Michigan , Ann Arbor, Michigan
| | - John Whited
- 23 Research and Development, Durham VA Medical Center , Durham, North Carolina
- 24 Department of Medicine, Duke University School of Medicine , Durham, North Carolina
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Pathipati AS, Ko JM. Implementation and evaluation of Stanford Health Care direct-care teledermatology program. SAGE Open Med 2016; 4:2050312116659089. [PMID: 27493756 PMCID: PMC4959300 DOI: 10.1177/2050312116659089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Teledermatology has proven to be an effective means of providing dermatologic care. The existing research has primarily evaluated its usefulness in a consultative model. Few academic centers have evaluated a patient-initiated model, and direct-to-consumer services remain the subject of controversy. Stanford Health Care recently launched a direct-care, patient-initiated teledermatology pilot program. This article evaluates the viability and patient satisfaction with this service. Materials and Methods: During the pilot period, patients were able to seek remote dermatologic care using an eVisit tool in their MyHealth account. Patients initiated the consultation, answered questions regarding their complaint, and uploaded a picture if relevant. A Stanford dermatologist reviewed each eVisit and responded with an assessment and plan. The dermatologist noted whether they were able to make a diagnosis and their level of confidence in it. After the study, 10 patients participated in a focus group to provide feedback on the service. Results: In all, 38 patients sought care during the pilot period. A dermatologist was able to make a diagnosis in 36 of 38 (95%) cases, with an average confidence level of 7.9 of 10. The average time to consultation was 0.8 days. Patients indicated high levels of satisfaction with the service although they had suggestions for improvement. Discussion: Patients provided clinically useful images and information in a direct-care teledermatology model. Such services allow dermatology providers to increase access while maintaining high-quality care in an academic medical center. Further research is needed on standalone services that cannot integrate encounters with the patient’s existing medical record.
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Affiliation(s)
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
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Weingast J, Scheibböck C, Wurm EM, Ranharter E, Porkert S, Dreiseitl S, Posch C, Binder M. A Prospective Study of Mobile Phones for Dermatology in a Clinical Setting. J Telemed Telecare 2016; 19:213-8. [DOI: 10.1177/1357633x13490890] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the accuracy of diagnoses made from pictures taken with the built-in cameras of mobile phones in a ‘real-life’ clinical setting. A total of 263 patients took part, who photographed their own lesions where possible, and provided clinical information via a questionnaire. After the teledermatology procedure, each patient was examined face-to-face and a gold standard diagnosis was made. The telemedicine data and pictures were diagnosed by 15 dermatologists. The 299 cases contained 1–22 clinical images each (median 3). Nine dermatologists finished all the cases and the remaining six completed some of them, thus providing 2893 decisions. Overall, 61% of all cases were rated as possible to diagnose and of those, 80% were correct in comparison with the face-to-face diagnosis. Image quality was evaluated and the median was 5 on a 10-point scale. There was a significant correlation between the correct diagnosis and the quality of the photographs taken ( P & 0.001). In nearly two-thirds of all cases, a teledermatology diagnosis was possible; however, there was insufficient information to make a telemedicine diagnosis in about one-third of the cases. If applied carefully, mobile phones could be a powerful tool for people to optimize their health care status.
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Affiliation(s)
- Jessika Weingast
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
- Center of Excellence for Telemedicine, Medical University of Vienna, Austria
| | - Christian Scheibböck
- Center of Excellence for Telemedicine, Medical University of Vienna, Austria
- Technical University of Vienna, Austria
| | - Elisabeth Mt Wurm
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
| | - Elisabeth Ranharter
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
| | - Stefanie Porkert
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
| | - Stephan Dreiseitl
- Department of Software Engineering, Upper Austria University of Applied Sciences at Hagenberg, Austria
| | - Christian Posch
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
| | - Michael Binder
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
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Lofgreen SJ, Ashack K, Burton KA, Dellavalle RP. Mobile Device Use in Dermatologic Patient Care. Curr Derm Rep 2016. [DOI: 10.1007/s13671-016-0132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Byrom L, Lucas L, Sheedy V, Madison K, McIver L, Castrisos G, Alfonzo C, Chiu F, Muir J. Tele-Derm National: A decade of teledermatology in rural and remote Australia. Aust J Rural Health 2015; 24:193-9. [DOI: 10.1111/ajr.12248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Byrom
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Lex Lucas
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Vicki Sheedy
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Kim Madison
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Lachlan McIver
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - George Castrisos
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Christina Alfonzo
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Frank Chiu
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Jim Muir
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
- South East Dermatology; Brisbane Queensland Australia
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Sharma P, Kovarik CL, Lipoff JB. Teledermatology as a means to improve access to inpatient dermatology care. J Telemed Telecare 2015; 22:304-10. [DOI: 10.1177/1357633x15603298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/07/2015] [Indexed: 11/16/2022]
Abstract
Many hospitals have limited inpatient dermatology consultation access. Most dermatologists are outpatient-based and may find the distance and time to complete inpatient consultations prohibitive. Teledermatology may improve access to inpatient dermatology care by reducing barriers of distance and time. We conducted a prospective two-phase pilot study at two academic hospitals comparing time needed to complete inpatient consultations after resident dermatologists initially evaluated patients, called average handling time (AHT), and time needed to respond to the primary team, called time to response (TTR), with and without teledermatology with surveys to capture changes in dermatologist opinion on teledermatology. Teledermatology was only used in the study phase, and patients were seen in-person in both study phases. Teledermatology alone sufficiently answered consultations in 10 of 25 study consultations. The mean AHT in the study phase (sAHT) was 26.9 min compared to the baseline phase (bAHT) of 43.5 min, a 16.6 min reduction ( p = 0.004). The 10 study cases where teledermatology alone was sufficient had mean study TTR (sTTR) of 273.3 min compared to a baseline TTR (bTTR) of 405.7 min, a 132.4 min reduction ( p = 0.032). Teledermatology reduces the time required for an attending dermatologist to respond and the time required for a primary team to receive a response for an inpatient dermatology consultation in a subset of cases. These findings suggest teledermatology can be used as a tool to improve access to inpatient dermatology care.
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Affiliation(s)
- Priyank Sharma
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jules B Lipoff
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
An important outcome in healthcare, and in particular for dermatologic healthcare, is quality of life. Whereas the literature is well represented by quality of life assessments in dermatology, very little information is available that specifically addresses teledermatology's impact on quality of life. This gap in our knowledge of teledermatology is noteworthy precisely because of the importance that quality of life plays in dermatologic disease and healthcare delivery. The goal of this review is to briefly outline the concept of quality of life and its importance to dermatology, describe the different type of instruments that are used to assess quality of life, and to review studies that implemented teledermatology interventions and made quality of life assessments. The available literature has shown that teledermatology interventions do result in improved quality of life, and those changes correlate with improvements in disease severity and clinical course. Integrating quality of life assessments in future evaluations of teledermatology interventions would be valuable to provide a more comprehensive depiction of teledermatology's impact on patients receiving dermatology care via telemedicine.
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Affiliation(s)
- John D Whited
- Division of General Internal Medicine, Research Service, Durham Veterans Affairs Medical Center, Duke University School of Medicine, Durham, NC, USA
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Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. J Am Acad Dermatol 2015; 72:563-74; quiz 575-6. [PMID: 25773407 DOI: 10.1016/j.jaad.2014.07.061] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 11/30/2022]
Abstract
Telemedicine is the use of telecommunications technology to support health care at a distance. Technological advances have progressively increased the ability of clinicians to care for diverse patient populations in need of skin expertise. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Moreover, there is a shortage of medical dermatologists in the United States, where skin disorders account for 1 in 8 primary care visits and specialists tend to congregate in urban areas. Even in regions where dermatologic expertise is readily accessible, teledermatology may serve as an alternative that streamlines health care delivery by triaging chief complaints and reducing unnecessary in-person visits. In addition, many patients in the developing world have no access to dermatologic expertise, rendering it possible for teledermatologists to make a significant contribution to patient health outcomes. Teledermatology also affords educational benefits to primary care providers and dermatologists, and enables patients to play a more active role in the health care process by promoting direct communication with dermatologists.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Joseph Kvedar
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Richard D Granstein
- Department of Dermatology, Weill Cornell Medical College, New York, New York.
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Coates SJ, Kvedar J, Granstein RD. Teledermatology: From historical perspective to emerging techniques of the modern era. J Am Acad Dermatol 2015; 72:577-86. [DOI: 10.1016/j.jaad.2014.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022]
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Abstract
Psoriasis is a relatively common chronic inflammatory skin disease in children for which there is no cure. Most children have mild disease that can be managed with topical therapy as opposed to phototherapy or systemic therapy. Despite the mild presentation of psoriasis in most children, the disease can have a significant impact on quality of life due to the need for ongoing treatment, the frequently visible nature of the cutaneous manifestations, and the social stigma that is associated with psoriasis. Adherence to treatment, in particular topical therapy, is often poor in adults and compromises response to therapy and medical provider management strategies. Multiple factors that may contribute to nonadherence in adults with psoriasis have been identified, including lack of education on the disease and expectations for management, issues related to ease of use and acceptability of topical medications, and anxiety regarding possible medication side effects. There is currently no published data on adherence in the pediatric psoriasis population; however, poor adherence is often suspected when patients fail to respond to appropriate therapy. General strategies used to assess adherence in other pediatric disease populations can be applied to children with psoriasis, and interventions that reflect experience in other chronic dermatologic disorders such as atopic dermatitis may also be helpful for medical providers caring for children with psoriasis.
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Affiliation(s)
| | - Sandra Cortina
- Division of Behavioral Medicine and Clinical Psychology.,Center for Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Frühauf J, Kröck S, Quehenberger F, Kopera D, Fink-Puches R, Komericki P, Pucher S, Arzberger E, Hofmann-Wellenhof R. Mobile teledermatology helping patients control high-need acne: a randomized controlled trial. J Eur Acad Dermatol Venereol 2014; 29:919-24. [PMID: 25258175 DOI: 10.1111/jdv.12723] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acne is an important health issue with a major psychological impact in addition to the physical problems it causes. OBJECTIVES To investigate the superiority of mobile teledermatology in the care of patients with high-need facial acne in comparison to outpatient services with particular attention to treatment efficacy, safety, and patient compliance. Further, patient satisfaction with remote care was evaluated. METHODS Sixty-nine consecutive patients (f: 25, m: 44, median age: 19 years, range: 13-37 years) were randomly allocated to either the teleconsultation (TCA) or the outpatient consultation (OCA) arm of the trial to receive isotretinoin treatment in weight and severity-dependent dosages over 24 weeks. Acne grading was performed by one examiner using the Global Acne Severity Scale (GEA) and the total lesion counting (TLC). RESULTS Due to noncompliance issues, 17 of 69 (24.6%) patients were excluded from the study, of who 10 had been assigned to the TCA (10/34; 29.4%) and 7 to the OCA (7/35; 20%). Both, in the TCA (GEA-score: ∆ = 2.25; TLC: ∆ = 89.08) and in the OCA (GEA-score: ∆ = 2.0; TLC: ∆ = 91.21) excellent and almost equivalent therapeutic outcomes were achieved. In the TCA, however, less patients experienced adverse reactions (P = 0.55). Even though additional live supervision would have been appreciated in some teledermatology cases, patients were satisfied with the mobile service and no consultation request was created. CONCLUSION Mobile teledermatology is an efficient, safe and well-accepted tool among patients with high-need acne constituting at least a valuable adjunct to outpatient care services. Further larger studies would be useful to confirm our findings.
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Affiliation(s)
- J Frühauf
- JF Private Dermatology Practice, Maria Enzersdorf, Lower Austria, Austria; Department of Dermatology, Medical University of Graz, Graz, Austria
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Kwon EJ, Ntiamoah P, Shulman KJ. The utility of C4d immunohistochemistry on formalin-fixed paraffin-embedded tissue in the distinction of polymorphic eruption of pregnancy from pemphigoid gestationis. Am J Dermatopathol 2013; 35:787-91. [PMID: 24061402 DOI: 10.1097/DAD.0b013e3182a6b6cc] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Polymorphic eruption of pregnancy (PEP), formerly known as pruritic urticarial papules and plaques of pregnancy, is a dermatosis of pregnancy that must be distinguished from pemphigoid gestationis (PG). Although this differential diagnosis may be possible on routine histology, an additional biopsy for direct immunofluorescence (DIF) is often needed. Recent studies have demonstrated the utility of anti-C4d or anti-C3d antibodies in the diagnosis of bullous pemphigoid (BP) in formalin-fixed paraffin-embedded tissue (FFPE). We investigated the utility of routine immunohistochemistry (IHC) for anti-C4d in FFPE tissue in the specific differential diagnosis of PEP versus PG in known, DIF-proven cases. We performed C4d IHC on PEP (n = 11), PG (n = 8), DIF-proven BP (n = 12), and other common dermatoses (n = 12) that are typically DIF negative. None of the PEP cases (0/11) or the other common dermatoses (0/12) demonstrated C4d positivity at the basement membrane zone. In comparison, 100% of PG cases (8/8) and 83.3% of BP cases (10/12) showed linear C4d immunoreactant deposition along the basement membrane zone. The results demonstrate the potential utility of C4d IHC in FFPE tissue for distinguishing PEP from PG, thus potentially obviating the need of a repeat biopsy for DIF, particularly in C4d-negative cases where there is a low suspicion of PG on both clinical and histological grounds. Also, patients with positive C4d-positive immunoreactivity may also potentially proceed directly to less invasive serological confirmatory testing, such as BP180 NC16a enzyme-linked immunoabsorbent assay.
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Abstract
BACKGROUND Topical vitamin D is approved by the US Food and Drug Administration for the treatment of psoriasis but is also used off-label in the treatment of a variety of cutaneous diseases despite a lack of evidence-based guidelines. OBJECTIVE The objective of this study was to provide evidence-based clinical guidelines for the off-label use of topical vitamin D in the treatment of dermatologic disease. METHODS A systematic literature review was conducted via the MEDLINE, Embase, and CENTRAL databases for off-label uses of topical vitamin D analogues in the treatment of dermatologic disease other than psoriasis. The data were synthesized, and evidence-based recommendations were rendered according to the highest level of evidence available. RESULTS A total of 165 articles met the inclusion criteria. A moderate to strong recommendation was given for the use of topical vitamin D in combination with corticosteroids and phototherapy in vitiligo and as monotherapy for various ichthyoses, morphea, pityriasis alba, prurigo nodularis, and polymorphous light eruption. There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars. CONCLUSION Topical vitamin D analogues have an important role in the off-label treatment of dermatologic disease, but higher quality studies are still required.
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Ryan C, Korman NJ, Gelfand JM, Lim HW, Elmets CA, Feldman SR, Gottlieb AB, Koo JY, Lebwohl M, Leonardi CL, Van Voorhees AS, Bhushan R, Menter A. Research gaps in psoriasis: Opportunities for future studies. J Am Acad Dermatol 2014; 70:146-67. [DOI: 10.1016/j.jaad.2013.08.042] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 08/24/2013] [Accepted: 08/26/2013] [Indexed: 02/08/2023]
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McFarland LV, Raugi GJ, Reiber GE. Primary Care Provider and Imaging Technician Satisfaction with a Teledermatology Project in Rural Veterans Health Administration Clinics. Telemed J E Health 2013; 19:815-25. [DOI: 10.1089/tmj.2012.0327] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lynne V. McFarland
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Department of Medicinal Chemistry, School of Public Health, University of Washington, Seattle, Washington
| | - Gregory J. Raugi
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Hospital and Specialty Medical Services, Teledermatology Section, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
| | - Gayle E. Reiber
- Health Services Research and Development, VA Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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Peeters JM, Wiegers TA, Friele RD. How technology in care at home affects patient self-care and self-management: a scoping review. Int J Environ Res Public Health 2013; 10:5541-64. [PMID: 24173139 PMCID: PMC3863859 DOI: 10.3390/ijerph10115541] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/18/2022]
Abstract
The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients’ role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients’ self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.
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Affiliation(s)
- José M. Peeters
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +31-30-272-9628; Fax: +31-30-272-9729
| | - Therese A. Wiegers
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
| | - Roland D. Friele
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, Utrecht 3513 CR, The Netherlands; E-Mails: (T.A.W.); (R.D.F.)
- Faculty of Social and Behavioural Sciences, Tilburg University, Warandelaan 2, Tilburg 5037 AB, The Netherlands
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Kaliyadan F, Amin TT, Kuruvilla J, Ali WHAB. Mobile teledermatology--patient satisfaction, diagnostic and management concordance, and factors affecting patient refusal to participate in Saudi Arabia. J Telemed Telecare 2013; 19:315-9. [PMID: 24163295 DOI: 10.1177/1357633x13501778] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We evaluated the use of a 4G smart phone for mobile teledermatology. A dermatologist took pictures of skin images with a mobile phone (8 Mpixel camera resolution) and made a face-to-face diagnosis. The images were transmitted to a second dermatologist who viewed them on a similar mobile phone and made an independent diagnosis for comparison. Images were taken and transmitted only after receiving informed consent from the patients. A total of 166 consecutive patients were included in the study (97 male and 69 female). A questionnaire to assess patient satisfaction was administered to each patient. Most of the responders were highly satisfied with teledermatology. However, 23 patients (14%) refused photography of the skin lesions (21 female and 2 males). The main reasons for refusal to be photographed were stated as social or religious. The broad categorical diagnostic and management concordance (i.e. when considering at least one of the diagnoses to be similar) was 95%. Specific diagnostic concordance varied according to the disease. The average kappa coefficient was 0.66 for diagnostic concordance and 0.82 for management concordance. Refusal to be photographed--a problem not limited to teledermatology--needs to be considered when designing teledermatology protocols for larger scale implementation in areas like the Middle East.
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Affiliation(s)
- Feroze Kaliyadan
- Faculty of Dermatology, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
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