Evaluating paediatric dermatology telephone clinics during COVID‐19 from a dual clinician and patient perspective: a prospective study

Abstract

Summary Background The landscape of dermatology services, already rapidly evolving into an increasingly digital one, has been irretrievably altered by the COVID‐19 (SARS‐CoV‐2) pandemic. Data are needed to assess how best to deliver virtual dermatology services in specific patient subgroups in an era of ongoing social distancing and beyond. Initial studies of teledermatology in paediatric populations suggest that many of the problems experienced in adult telemedicine are more apparent when treating children and come with additional challenges. Aim To evaluate the efficacy of a virtual paediatric dermatology telephone clinic in comparison to traditional face‐to‐face (FTF) clinics, both from the clinician and patient/parental perspective. Methods We carried out a prospective service evaluation examining a single centre cohort of paediatric dermatology patients managed during the COVID‐19 pandemic via a telephone clinic supported by images. The study period covered June–September 2020. Data on outcomes were collected from clinicians and a qualitative patient/parental telephone survey was undertaken separately. A five‐point Likert scale was used to assess both satisfaction and levels of agreement regarding whether a telephone clinic was more convenient than an FTF clinic. Results Of 116 patients included, 24% were new and 76% were follow‐up patients, with a mixture of inflammatory dermatoses (75%) and lesions (25%). From the clinician's perspective, most consultations (91%) were successfully completed over the telephone. However, qualitative patient and parent feedback paradoxically illustrated that although nearly all (98%) respondents had no outstanding concerns, 52% felt highly unsatisfied and only 22% agreed that telephone clinics were more convenient. Most (65%) preferred FTF follow‐up in the future. Statistical analysis using χ² test showed that among those with established follow‐ups, the preference for future consultation type was independent of specific reasons for follow‐up. Conclusions Our study demonstrates a clear discrepancy between the practical successes of a virtual service from the clinician’s perspective compared with the patient/parental perspective. Parental anxiety appears to be less effectively allayed virtually than with FTF. This raises the question of whether there is a role for virtual paediatric telephone clinics in the postpandemic future, which may be better left to patients/parents to decide on an individual basis.

Efficacy, perception, and utilization of pediatric teledermatology: A systematic review

“…The most common conditions evaluated utilizing pediatric teledermatology were atopic dermatitis, inflammatory dermatoses, benign melanocytic nevi, infantile hemangioma (IH), molluscum contagiosum, verruca vulgaris, and acne. 8 , 12 , 13 , 14 , 15 , 17 , 18 There was little divergence from conditions commonly treated by pediatric dermatologists during in-person encounters. 16 A cross-sectional retrospective study by Giavina Bianchi et al 13 found that the use of store-and-forward photography enabled 63% of pediatric skin lesions identified in the primary care setting to be managed without an in-person visit.…”

“…During the pandemic, 1 study found that the majority of pediatric teledermatology encounters consisted of “inflammatory dermatoses” (75%), primarily atopic dermatitis. 12 A minority of diagnoses were described as “lesions” (25%), the most prevalent of which was IH. 12 Duan et al 15 also found that patients and families more often chose teledermatology for diagnosis and management of acne, IH, and contact dermatitis rather than atopic dermatitis, verruca vulgaris, and alopecia areata.…”

“… 12 A minority of diagnoses were described as “lesions” (25%), the most prevalent of which was IH. 12 Duan et al 15 also found that patients and families more often chose teledermatology for diagnosis and management of acne, IH, and contact dermatitis rather than atopic dermatitis, verruca vulgaris, and alopecia areata. Despite numerous studies demonstrating treatment of skin conditions via telemedicine, 8 , 12 , 13 , 14 , 15 , 17 , 18 consensus on the optimal modality for management of individual dermatologic diseases in the pediatric population remains unclear.…”

“… 27 In one survey, 98.4% of patients were either somewhat satisfied or very satisfied with their telemedicine encounters, 23 while other studies showed parent satisfaction of 77% 19 and 70%. 26 Conversely, Lowe et al 12 found that 52% of patients and parents were unsatisfied with telephone consultations. While 65% of respondents preferred face-to-face encounters in the future, 98% had no outstanding concerns after their televisit.…”

Access to pediatric dermatology

“…Additionally, patient satisfaction varies between different telehealth modalities. In a recent study, 69% of parents were slightly or highly unsatisfied with their child's telephone dermatology visit, despite that most reported no outstanding concerns from the consultation [44 ▪ ]. The appropriateness of teledermatology varies by diagnosis, patient complexity, and whether the patient is new or established [45,46].…”