A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review

Long, Valencia; Chandran, Nisha Suyien

doi:10.2196/34228

Cited by 7 publications

(4 citation statements)

References 20 publications

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“…The sheer increase in the volume of care due to a lack of access to alternatives and improved reimbursement likely drove a wider demographic reach in the patient population. This trend coincides with increased calls for equitable inclusion in dermatology studies [55] and studies highlighting how teledermatology may exacerbate digital inequity [4,[56][57][58][59][60]. As a result, lack of access combined with increased awareness of social inequities in care possibly encouraged researchers to be more intentional in seeking broader demographic variables to ensure their teledermatology programs represented underserved and underrepresented communities.…”

Section: Demographic Data Reported and Covid-19mentioning

confidence: 69%

Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review

Miller¹,

Ioffreda²,

Nugent³

et al. 2023

JMIR Dermatol

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Background Patient-to-provider teledermatology relies on a patient’s access to technology to ensure a successful visit. However, access to broadband internet and technology varies across populations in the United States—leading to the digital divide. While teledermatology has been recognized as a model to improve access, little is known about how often demographic data associated with digital inequity are captured in studies. Objective Given the expansion of teledermatology over the past decade, we sought to determine how often demographic data associated with digital inequity are reported in patient-to-provider teledermatology studies. Methods A scoping literature review search was conducted using the search term teledermatology in the following databases: PubMed, Embase, and the Cochrane Database of Systematic Reviews. All studies published between December 31, 2011, and December 31, 2021, that evaluated patient-to-provider teledermatology were eligible. Results In total, 1412 publications describing teledermatology were identified, of which 46 met the inclusion criteria. Race or ethnicity was the most frequently reported demographic characteristic (28/46, 61%). However, only 41% (19/46) of studies were representative of race or ethnicity, defined as including >20% nonwhite participants. Studies rarely reported the number of participants greater than 65 years of age (14/46, 30%), preferred language (9/46, 20%), income (6/46, 13%), highest level of education (5/46, 11%), or access to a device (4/46, 9%). Studies conducted after the onset of the COVID-19 pandemic were significantly more likely to report preferred language (9/25, 36% vs 0%; P=.002) and appeared more likely to report other demographic data associated with digital inequity, without reaching statistical significance (P>.05). Conclusions Demographic data associated with digital inequity are rarely reported in patient-to-provider teledermatology studies to date. These studies frequently lack adequate representation of racial and ethnic minorities. With increased calls for equitable representation in dermatology studies, future teledermatology studies can improve the reporting of race and ethnicity and consider demographic data associated with digital inequity as an important criterion in research design.

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Section: Demographic Data Reported and Covid-19mentioning

confidence: 69%

Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review

Miller¹,

Ioffreda²,

Nugent³

et al. 2023

JMIR Dermatol

View full text Add to dashboard Cite

show abstract

“…Physical accessibility is also seldom an issue in the city-state of Singapore; thus, the time and cost savings from transportation for medical care are marginal. Furthermore, consulting a dermatologist physically is financially accessible to most Singaporeans, and teledermatology is therefore not used as a means to access care (as opposed to some underserved areas in the United States where teledermatology through a store-and-forward system may be the only affordable avenue for patients to access dermatological consult) [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

Where Are We With Teledermatology? Two Years in the Wake of COVID-19

Sim¹,

Choi²,

Chandran³

2023

JMIR Dermatol

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“…Most respondents (76%) used parent-submitted photographs to supplement video visits, and a majority (73.4%) of clinicians who lacked photographs believe that photographs would have helped with the diagnosis [ 48 ]. Therefore, hybrid teledermatology visits using both synchronous and asynchronous communication may become more prevalent in practice [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Reimbursement for the evaluation of patient-submitted images has been proposed but not implemented by the Centers for Medicare and Medicaid Services [ 56 ]. Given that telephone-based consultation has a definitive reimbursement model that has become more flexible following the pandemic, a similar policy should be considered for SAF teledermatology services, especially those that supplement other web-based appointments [ 49 ]. Patient privacy, complex SAF teledermatology workflows, and the lack of a definitive reimbursement model are key challenges that need to be addressed with more widespread adoption of SAF teledermatology.…”

Section: Discussionmentioning

confidence: 99%

Store-and-Forward Images in Teledermatology: Narrative Literature Review

Jiang¹,

Flynn²,

Kwock³

et al. 2022

JMIR Dermatol

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Background Store-and-forward (SAF) teledermatology uses electronically stored information, including patient photographs and demographic information, for clinical decision-making asynchronous to the patient encounter. The integration of SAF teledermatology into clinical practice has been increasing in recent years, especially during the COVID-19 pandemic. Despite this growth, data regarding the outcomes of SAF teledermatology are limited. A key distinction among current literature involves comparing the quality and utility of images obtained by patients and trained clinicians, as these metrics may vary by the clinical expertise of the photographer. Objective This narrative literature review aimed to characterize the outcomes of SAF teledermatology through the lens of patient- versus clinician-initiated photography and highlight important future directions for and challenges of the field. Methods A literature search of peer-reviewed research was performed between February and April 2021. Key search terms included patient-initiated, patient-submitted, clinician-initiated, clinician-submitted, store-and-forward, asynchronous, remote, image, photograph, and teledermatology. Only studies published after 2001 in English were included. In total, 47 studies were identified from the PubMed electronic database and Google Scholar after omitting duplicate articles. Results Image quality and diagnostic concordance are generally lower and more variable with patient-submitted images, which may impact their decision-making utility. SAF teledermatology can improve the efficiency of and access to care when photographs are taken by either clinicians or patients. The clinical outcomes of clinician-submitted images are comparable to those of in-person visits in the few studies that have investigated these outcomes. Coinciding with the onset of the COVID-19 pandemic, asynchronous teledermatology helped minimize unnecessary in-person visits in the outpatient setting, as many uncomplicated conditions could be adequately managed remotely via images captured by patients and referring clinicians. For the inpatient setting, SAF teledermatology minimized unnecessary contact during dermatology consultations, although current studies are limited by the heterogeneity of their outcomes. Conclusions In general, photographs taken by trained clinicians are higher quality and have better and more relevant diagnostic and clinical outcomes. SAF teledermatology helped clinicians avoid unnecessary physical contact with patients in the outpatient and inpatient settings during the COVID-19 pandemic. Asynchronous teledermatology will likely play a greater role in the future as SAF images become integrated into synchronous teledermatology workflows. However, the obstacles summarized in this review should be addressed before its widespread implementation into clinical practice.

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A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review

Cited by 7 publications

References 20 publications

Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review

Demographic Data Associated With Digital Inequity Reported in Patient-to-Provider Teledermatology Studies in the United States From 2011 to 2021: Scoping Review

Where Are We With Teledermatology? Two Years in the Wake of COVID-19

Store-and-Forward Images in Teledermatology: Narrative Literature Review

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