Can teledermatology be a useful diagnostic tool in dermatology practice in remote areas? An Egyptian experience with 600 patients

Abstract

Introduction The paucity of studies evaluating teledermatology (TD) in developing countries was the impetus behind conducting this work. We aimed to evaluate the feasibility and reliability of TD in remote areas where medical facilities and consultant dermatologists are not available, through measurement of diagnostic concordance rates between face-to-face diagnosis and store-and-forward (SAF) TD diagnosis. Methods A total of 600 patients with dermatological ailments who attended Abshway Hospital were recruited into the study, examined by an on-site dermatology resident, and offered a diagnosis. The clinical images and patients' history were collected and transferred (through the Dropbox application) to two remote consultant dermatologists. The reliability of the three physicians' agreement rates was assessed. Results Diagnostic agreement rates between the face-to-face dermatologist and the two teledermatologists were 86.7% and 87% respectively. Of the cases, 97% had complete or partial agreement and 81.3% of cases showed complete agreement between the three physicians. The reliability of the three physicians' agreement rates was assessed statistically using Cohen's kappa coefficient (κ) and this showed a range of 0.46-0.52. Conclusion This study might aid in enhancing the utilization of this tool in our country, especially in remote areas with a lack of a proper dermatological service. The simplicity and low cost of the adopted technique might facilitate its use over large sectors. It opens the door for gaining the benefit of this technology in other aspects such as teaching and monitoring health care providers.

Use of Teledermatology to Improve Dermatological Access in Rural Areas

“…34 A study conducted in a remote area in Egypt revealed 81.3% complete concordance and 97% partial/complete concordance rates, indicating that the cost-effective teleservice could enable educational programs and monitoring of practitioners. 35 Within a nonrural context, a prospective study conducted in underserved, urban primary facilities in Philadelphia revealed that teledermatology could enhance outpatient care access and clinical results in these facilities by resolving diagnostic disagreements between primary care practitioners and dermatologists. 36 For the dermatologist, clinical images of good quality have enhanced diagnostic precision.…”

“…Saleh et al 35 An analytical study was conducted in a remote area of Egypt to assess the telesystem by determining diagnostic concordance rates between face-to-face dermatologists and teledermatologists.…”

Implementation of Teledermatology: Theory and Practice

“…In low-and moderate-income countries, particularly in remote areas, teledermatology has increased access, broadly defined as numbers of teledermatology encounters, as shown by studies in Afghanistan [32], 12 sub-Saharan African countries [33], and Mali [34]. Secure messaging as a vehicle for increasing teledermatology reach has been reported in Botswana [35] and Argentina [36], while a common commercial file sharing resource has been used in Egypt [37]. In Brazil, teledermatology has expanded to cover the entire state of Catarina with 83,100 completed consults from January 2014 to June 2018 [38].…”

Wie offen ist die bayerische Bevölkerung für Teledermatologie? Eine Querschnittsstudie in ländlichen und städtischen Regionen Bayerns

“…Im Rahmen der TD bieten sich SaF-Technologien besonders an, da sie nicht nur mit größerer Zeit-und Kostenersparnis verbunden sind [7], sondern da die meisten Hauterkrankungen gut sichtbar sind und somit gut auf Fotos abgebildet werden können, die anschließend an den Dermatologen übermittelt werden können. Vor allem in ländlichen Räumen bietet TD einige Potenziale für eine verbesserte medizinische Versorgung [7][8][9]. TD kann dabei nicht nur eine ausreichende dermatologische Versorgung in unterversorgten Gebieten sicherstellen, sondern auch die Anzahl benötigter face-to-face Termine bei Dermatologen senken und so lange Anfahrten und Wartezeiten vermeiden beziehungsweise verkürzen [10].…”