Diagnosis, Diagnostic Confidence, and Management Concordance in Live-Interactive and Store-and-Forward Teledermatology Compared to In-Person Examination

Abstract

Teledermatology studies have examined diagnostic concordance between live-interactive (LI) and in-person examinations (IP); and between store-and-forward (SF) and IP examinations. However, no studies have looked simultaneously across all three care delivery modalities, and few have measured management concordance and diagnostic confidence of the dermatologist. The purpose of this study was to compare LI and SF modalities with IP with respect to diagnostic and management concordance and to compare physician diagnostic confidence across the three modalities. Four dermatologists, in random rotation among all three care modalities, examined 110 new patients. Confidence was rated on a Likert scale from 1 to 5 (5 = total confidence; 1 = no confidence). Identical diagnoses were given to the patient by examiners from all three examination modalities in 70/110 patients (64%). More identical diagnoses were given for IP and LI examinations than for IP and SF examinations (80% vs. 73%); however, the difference was not statistically significant (p = 0.13). The highest self-reported confidence rating was given for 87% of IP examinations, 59% for LI, and 54% for SF. Diagnostic confidence ratings for SF and LI were not significantly different from each other (p = 0.50); however, diagnostic confidence ratings for LI and SF were both statistically lower than IP (p < 0.0001). Dermatologists were more confident with IP examination than either form of teledermatology. The percent of diagnostic and management agreement among IP, LI, and SF modalities was high.

Comparing High Definition Live Interactive and Store-and-Forward Consultations to In-Person Examinations

“…4 Three studies compared the two modes. 14,23,24 In one study, 23 patients were not seen in-person, while another found identical diagnoses with in-person for 64% of patients with greater agreement for live interactive than store-and-forward that was not statistically significant. 24 A third study showed combining methods significantly increases concordance with in-person exams.…”

“…14 Although live interactive and store-and-forward methods have been compared before 14,23,24 the studies comparing remote methods to in-person 14,24 used diagnoses of single inperson dermatologists. This study extends teledermatology research by directly comparing concordance between inperson, live interactive, and store-and-forward methods with two in-person dermatologists establishing a diagnostic comparison baseline, while also addressing confidence and biopsy decisions and effects of video quality in live interactive consultations.…”

A telemedicina alkalmazása a bőrgyógyászatban: a teledermatológia

“…Szá-mos klinikai kutatás vizsgálta a teledermatológia orvosi alkalmazásának megbízhatóságát [1,8,28,33,[34][35][36][37][38].…”

“…A teledermatológiai módszerrel diagnosztizálható betegek esetén a diagnózis megbízha-tósága 90%-os volt. Edison és mtsai módszere szerint [34] minden pácienst háromszor vizsgáltak meg más-más orvosok: egyszer személyesen, egyszer store-andforward módszerrel és egyszer valós idejű konzultáció során. Azt tapasztalták, hogy a különböző orvosok által felállított store-and-forward telemedicina esetén 73%-os a diagnózis egyezése a személyes konzultációval, míg valós idejű konzultáció esetén ennél magasabb, mintegy 80%.…”

Teledermatology: Outcomes and Economic Considerations

“…Complete Diagnostic Agreement Partial Diagnostic Agreement (Tan et al, 2010) .75-.82 .83-.89 (Heffner et al, 2009) .69 - (Silva et al, 2009) .87-.92 .96-1.0 (Edison et al, 2008) .73 - (Ebner et al, 2008) . 71-.76 .90-.97 (Bowns et al, 2006) .55 - (Oakley et al, 2006) .53 .64 (Tucker & Lewis, 2005) .56 .68 (Baba et al, 2005) .75 - (Mahendran et al, 2005) .44-.48 .64-.65 (Du Moulin et al, 2003) .54 .63 (Eminovic et al, 2003) .41 .51 (Lim et al, 2001) .73-.85 .83-.89 (Taylor et al, 2001) .44-.51 .57-.61 (High et al, 2000) .64-.77 .81-.89 (Whited et al, 1999) .41-.55 .79-.95 (Lyon & Harrison, 1997) .89 - (Zelickson & Homan, 1997) .88 - (Kvedar et al, 1997) .61-.64 .67-.70 Table 2.…”