Teledermatology reduces dermatology referrals and improves access to specialists

Abstract

Background: Teledermatology may be used for triage in primary care to address skin conditions, improving access and reducing time to treat the most severe or surgical cases. We aimed to evaluate the proportion of individuals who could be assessed in primary care using teledermatology, and how this affected the waiting time for an in-person dermatologist appointment. Methods: A cross-sectional retrospective study, involving 30,976 individuals and 55,624 skin lesions, was performed from July 2017 to July 2018 We assessed the frequency of diagnoses and referrals to biopsy, to in-person dermatologists, or to primary care, and compared the waiting time for an in-person dermatologist appointment before and after the teledermatology implementation. Findings: 53% of the patients were managed with the primary care physician, 43% were referred to in-person dermatologists and 4% directly to biopsy, leading to a reduction of 78% in the waiting time for in-person appointments when compared to the previous period. The most frequent diseases were: melanocytic nevus, seborrheic keratosis, acne, benign neoplasms, onychomycosis, atopic dermatitis, solar lentigo, melasma, xerosis, and epidermoid cyst, with significant differences according to sex, age and referrals. The most frequent treatment prescribed was emollient. Interpretation: The use of teledermatology as a triage tool significantly reduced the waiting time for in-person visits, improving health care access and utilizing public resources wisely. Knowledge of sex, age, diagnoses and treatment of common skin conditions can enable public policies for the prevention and orientation of the population, as it can be used to train general physicians to address such cases.

Implementation of artificial intelligence algorithms for melanoma screening in a primary care setting

“…Since 2017, our group has had access to more than 100,000 clinical images of the HIAE’s teledermatology project [ 20 ]. Despite the protocols available and an app guiding the PCPs to collect the data, several pictures in the dataset contain artifacts, such as clothes, rings or even showing parts of the office’s furniture.…”

“…This leads patients that live far from large urban centers to travel long distances to have access to dermatologists. Due to the high demand for these professionals, even in big cities, the waiting time for an appointment can be more than 6 months [ 20 ].…”

Accuracy of Deep Neural Network in Triaging Common Skin Diseases of Primary Care Attention

“…140,446 images were utilized corresponding to 57,568 skin lesions, obtained between July 2017 and August 2018 from a philanthropic assistance project between Albert Einstein Israel-Brazilian Benevolent Society and the São Paulo City Hall. The project and its results have been described in detail previously ( 1 ).…”

“…It becomes even more evident when the necessary assistance requires a specialized professional. In Brazil, the specialty of Dermatology was the second-most referred to by primary care physicians, amounting to 17.78% of all the referrals with the average waiting time being more than 100 days for an appointment ( 1 , 2 ).…”

Etiologies of Melanoma Development and Prevention Measures: A Review of the Current Evidence

“…The expansion of telemedicine beyond COVID-19 can extend legitimate and convenient medical care to patients, as virtual health consultations may help alleviate the gaps in specialist care caused by some of the geographic and socioeconomic disparities discussed above. Teledermatology has increased access to providers by decreasing wait times and removing obstacles that interfere with care access, such as geographic location, scheduling, and travel [ 131 ].…”