Using Implementation Science to Understand Teledermatology Implementation Early in the COVID-19 Pandemic: Cross-sectional Study (Preprint)

Abstract

BACKGROUND Implementation science has been recognized for its potential to improve the integration of evidence-based practices into routine dermatologic care. The COVID-19 pandemic led to rapid teledermatology implementation worldwide. While several studies highlighted patient and provider satisfaction with teledermatology during the COVID-19 pandemic, less is known about the implementation process. OBJECTIVE Our goal was to use validated tools from implementation science to develop a deeper understanding of the implementation of teledermatology during the COVID-19 pandemic. Our primary aims were to describe a) the acceptability and feasibility of the implementation of teledermatology and b) organizational readiness for the implementation of teledermatology during the COVID-19 pandemic. We also sought to offer an example of how implementation science can be used in dermatologic research. METHODS An anonymous, online survey was distributed to Association of Professors of Dermatology members. It focused on a) the acceptability, feasibility, and appropriateness of teledermatology b) organizational readiness for implementing teledermatology c) the volume of teledermatology visits during the peak of implementation. It incorporated sub-scales from the Organizational Readiness to Change Assessment (ORCA), a validated measure of organizational characteristics that predict implementation success. RESULTS Of the 518 dermatologists emailed, 35 responded (6.8% response rate) and all endorsed implementing or scaling-up teledermatology during the pandemic. 100% of providers with the highest levels of organizational readiness said they plan to use teledermatology after the pandemic. Most agreed or strongly agreed that they had sufficient training (68.6%), financial resources (57.1%), and facilities (57.2%). However, only 42.8% agreed or strongly agreed that they had adequate staffing support. Most respondents considered the most acceptable teledermatology modality to be synchronous audio/video visits with supplemental stored digital photos (65.7%), and the least acceptable to be telephone visits without stored digital photos (17.2%). Overall, most respondents thought the implementation of synchronous audio/video with stored digital photos (31, 88.6%) and telephone visits with stored digital photos (31, 88.6%) were the most feasible. When asked about types of visits that were acceptable for teledermatology, 35.7% said new patients, 90.6% said existing patients, 90.6% said medication monitoring, 6.3% said total body skin exams, and 15.6% said lesions of concern. CONCLUSIONS This study serves as an introduction to how implementation science research methods can be used to understand the implementation of novel technologies in dermatology. Our work builds upon prior studies by further characterizing the acceptability and feasibility of different teledermatology modalities. Lastly, our study may suggest initial insights on how dermatology practices and health care systems can support dermatologists to successfully incorporate teledermatology after the pandemic.