Abstract
OBJECTIVE
To analyze the diagnostic agreement rate between primary care, an asynchronous teledermatology consultation, and a conventional dermatology consultation.
DESIGN
Prospective non-randomized concordance study.
SETTING
Dermatology Service in Hospital Son Llàtzer (Palma de Mallorca) and primary care centers of Sóller and Arenal (Mallorca).
PARTICIPANTS
Patients have been included from December 2005 to July 2008, sent by teleconsultation (n=158).
MAIN MEASUREMENTS
Analysis of primary care, teledermatology consultation and face-to-face consultation diagnosis, in mentioned period of time. Calculation of kappa index of concordance.
RESULTS
158 teleconsultations have been made from December 2005 to July 2008, 94 (59,5%) women, and 64 (40,5%) men, aged from 9 to 96 years old (average, 55 years old). After grouping the diagnosis in categories, the distribution was: 48 (37,2%) benign tumours, 39 (30,2%) inflammatory and appendages diseases, 15 (11,6%) infectious diseases, 14 (10,9%) malignant tumours, and 13 (10,1%) premalignant tumours. In grouped diagnosis, concordance was 59,8% (CI 95%, 50-70%) (P<.0001) for general practitioner and 94,7% (CI 95%, 90-99%) (P<.0001) for teledermatologist.
CONCLUSIONS
The main advantage of asynchronous teledermatology is the improvement of the quality triage, allowing the detection of malignant or suspicious lesions. However, we need more comparable studies on a larger scale to evaluate the disadvantages (photographic technique limitation, evaluation of other lesions, legal aspects, professional motivation...).
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