Real-world direct-to-patient teledermatology in a low-income, elderly population

Cline, Abigail; Kim, Carey; Deitz, Marcia; Rizzo, Amilcar; Thagirisa, Anil; Asrani, Falguni; Safai, Bijan; Marmon, Shoshana

doi:10.1016/j.jaad.2021.01.038

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…Around one-quarter of adults with household income below US $30,000 report they do not own a smartphone, whereas smartphone ownership is nearly 100% among adults in households earning US $100,000 or more a year [11]. To overcome this financial barrier to remote care, access to a mobile device may need to be considered a medical necessity for low-income, geographically isolated patients [28].…”

Section: Principal Findingsmentioning

confidence: 99%

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Lamb¹,

Fitzsimmons²,

Sevagamoorthy³

et al. 2022

JMIR Dermatol

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Background The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient’s skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. Objective The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. Methods We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. Results In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. Conclusions Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care.

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Section: Principal Findingsmentioning

confidence: 99%

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Lamb¹,

Fitzsimmons²,

Sevagamoorthy³

et al. 2022

JMIR Dermatol

View full text Add to dashboard Cite

show abstract

“… 13 In traditional teledermatology, these photographs are difficult to obtain because patients, such as the elderly, may lack the required digital literacy, access to technology, or ability to capture photos of difficult to reach areas if they live alone. 14 , 15 Patients with limited dexterity, tremors, cognitive impairment, or visual impairment may face challenges with operating technology and capturing high‐quality photographs required for teledermatology triage. 14 While the COVID‐19 pandemic led to rapid adoption of telemedicine in the general population, elderly patients accounted for only 8% of total teledermatology visits at Stanford dermatology clinics during the pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…Effective teledermatology screening requires high‐quality full body and close‐up photographs for accurate evaluation 13 . In traditional teledermatology, these photographs are difficult to obtain because patients, such as the elderly, may lack the required digital literacy, access to technology, or ability to capture photos of difficult to reach areas if they live alone 14,15 . Patients with limited dexterity, tremors, cognitive impairment, or visual impairment may face challenges with operating technology and capturing high‐quality photographs required for teledermatology triage 14 .…”

Section: Introductionmentioning

confidence: 99%

Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID‐19 pandemic: A pilot programme

Trinh

Yekrang

Phung

et al. 2022

Skin Health and Disease

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Background Elderly patients in senior communities faced high barriers to care during the COVID‐19 pandemic, including increased vulnerability to COVID‐19, long quarantines for clinic visits, and difficulties with telemedicine adoption. Objective To pilot a new model of dermatologic care to overcome barriers for senior living communities during the COVID‐19 pandemic and assess patient satisfaction. Methods From 16 November 2020 to 9 July 2021, this quality improvement programme combined in‐residence full body imaging with real‐time outlier lesion identification and virtual teledermatology. Residents from the Sequoias Portola Valley Senior Living Retirement Community (Portola Valley, California) voluntarily enroled in the Stanford Skin Scan Programme. Non‐physician clinical staff with a recent negative COVID‐19 test travelled on‐site to obtain in‐residence full body photographs using a mobile app‐based system on an iPad called SkinIO that leverages deep learning to analyse patient images and suggest suspicious, outlier lesions for dermoscopic photos. A single dermatologist reviewed photographs with the patient and provided recommendations via a video visit. Objective measures included follow‐up course and number of skin cancers detected. Subjective findings were obtained through patient experience surveys. Results Twenty‐seven individuals participated, three skin cancers were identified, with 11 individuals scheduled for a follow up in‐person visit and four individuals starting home treatment. Overall, 88% of patients were satisfied with the Skin Scan programme, with 77% likely to recommend the programme to others. 92% of patients agreed that the Skin Scan photographs were representative of their skin. In the context of the COVID‐19 pandemic, 100% of patients felt the process was safer or comparable to an in‐person visit. Despite overall appreciation for the programme, 31% of patients reported that they would prefer to see dermatologist in‐person after the pandemic. Conclusions This programme offers a framework for how a hybrid skin scan programme may provide high utility for individuals with barriers to accessing in‐person clinics.

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“…None of the 3 studies with results report income or Medicaid beneficiary status. A study of direct-to-patient teledermatology in a low-income, older adult population found that among those older than 65 years, nearly 32.7% of encounters involved use of video and/or photo sharing compared to 60.6% among those aged <65 years [ 10 ]. The pursuit of health equity through use of teledermatology should address the intersecting dimensions of digital literacy with demographic and socioeconomic status contexts.…”

mentioning

confidence: 99%

Gender and Ethnic Disparities in Teledermatology Clinical Trial Participants: Cross-Sectional Analysis of ClinicalTrials.gov-Registered Trials

Shah¹,

Saliba²

2023

JMIR Dermatol

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Real-world direct-to-patient teledermatology in a low-income, elderly population

Cited by 6 publications

References 3 publications

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Partnering with a senior living community to optimise teledermatology via full body skin screening during the COVID‐19 pandemic: A pilot programme

Gender and Ethnic Disparities in Teledermatology Clinical Trial Participants: Cross-Sectional Analysis of ClinicalTrials.gov-Registered Trials

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