Original article
Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers

https://doi.org/10.1016/j.jaad.2017.09.017Get rights and content

Background

The clinical outcome of teledermatology with dermoscopy in large-scale primary care networks remains unclear.

Objective

We evaluate the impact of implementing a teledermatology consultation program with dermoscopy on a statewide scale, focusing on access to care and skin cancer screening for medically underserved populations.

Methods

Descriptive retrospective cohort study of 2385 dermatology referrals from primary care from June 2014 through November 2015.

Results

Before implementation of electronic consultations (eConsults), access to dermatology was limited; only 139 (11%) of 1258 referrals resulted in a confirmed appointment with a median wait time of 77 days. Post implementation, 499 of 1127 consults (44%) were sent electronically, and of those, 16% required a face-to-face visit with a median wait time of 28 days. Ten malignancies were identified via eConsults. Overall consult volume remained stable pre- and post-eConsult implementation.

Limitations

We evaluated eConsults in medically underserved populations seeking care at community health centers. Results might not be generalizable to other populations or in other settings.

Conclusion

eConsults increase access to dermatologic care and reduce wait times for patients receiving medical care at community health centers. Implementing dermoscopy into teledermatology could increase access to skin cancer screening and treatment for medically disadvantaged populations.

Section snippets

Study design

This study used a descriptive retrospective cohort design and was reviewed and approved by the Institutional Review Board of Community Health Center Inc. There were 2 comparison groups: patients referred to dermatology during the 6 months before implementation of eConsults and patients referred during the 6-month period after eConsult implementation. The post-eConsult group was further subdivided into 2 subgroups: patients send to eConsult and patients directly sent for a face-to-face (F2F)

Referral request outcomes

Fig 1 shows the outcome for all 2385 dermatology consult requests. There were 1258 consults in the pre-eConsult period and 1127 in the post-eConsult period. Patients in these 2 groups were similar, with minor but significant differences in age and race (Table I). For the pre-eConsult group, 744 patients (59%) received an appointment, and only 139 (11%) patients had a confirmed visit with a dermatologist. Of 1127 consults requested in the post-eConsult period, 628 (56%) were for a F2F visit,

Discussion

This study demonstrates that significant improvement in access to dermatologic care can be obtained when eConsults are implemented in a safety net health system. Consistent with previous studies,7, 8, 18, 19, 20 the intervention resulted in marked improvement to access. However, unlike previous work, these findings demonstrate how eConsults perform on a larger scale, in a nonclosed system where providers had free choice whether to use the system or not, and where the reviewing dermatologists

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      Citation Excerpt :

      In this study, 11% of referrals resulted in a confirmed appointment (median wait time 77 days) before implementation of e-consults. After implementation, 44% of consults were sent via e-consults, and 16% of those required in-person consultation with a median wait time of 28 days.25 In another study of Medicaid claims data, of patients who received dermatologic care, 48.5% did so via teledermatology.

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    Ms Naka and Dr Lu contributed equally to this work.

    Funding sources: Supported by the Jesse B. Cox Charitable Trust.

    Conflicts of interest: None declared.

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