Studies gather evidence of success of teledermatology

April Armstrong, MD, MPH: “It appears that live-interactive teledermatology, in terms of diagnostic concordance, is a little bit higher than store-and-forward teledermatology.”

April Armstrong, MD, MPH: “It appears that live-interactive teledermatology, in terms of diagnostic concordance, is a little bit higher than store-and-forward teledermatology.”

Technological advances have obviously created opportunities for greater use of teledermatology, but the big question is “Do patients receive the same quality of treatment through teledermatology compared with in-person diagnosis and treatment?” The evidence suggests that the answer is “yes.”

“Overall, the evidence is good supporting the use of teledermatology. Specifically, the diagnostic concordance of store-and-forward teledermatology or live-interactive teledermatology compared to face-to-face care is good,” said April Armstrong, MD, MPH. She reported on studies of teledermatology in her presentation, “Does the Evidence Support the Use of Telemedicine in Practice?”

“It appears that live-interactive teledermatology, in terms of diagnostic concordance, is a little bit higher than store-and-forward teledermatology. The rates are higher for face-to-face compared to store-and-forward,” said Dr. Armstrong. She is vice chair of clinical research and associate professor of dermatology at the University of Colorado School of Medicine.

There are two types of teledermatology. Live-interactive is also known as real-time dermatology, where there is direct interaction between the patient and a health care professional. In store-and-forward dermatology, images are captured, stored, and forwarded to a dermatologist for diagnosis.

In studies that had different dermatologists look at the same photographs of patients to make a diagnosis, the diagnostic concordance between store-and-forward and live-interactive is about 75 percent. The diagnostic concordance between live-interactive and in-person is 80-85 percent, Dr. Armstrong said.

Also of great importance, though, is the accuracy of diagnosis. A diagnosis could be inaccurate for both teledermatology and in-person dermatology, leading to good diagnostic concordance, but it does not help treatment.

“Accuracy is based on the gold standard of biopsy,” Dr. Armstrong said. “Based on biopsy results, we know that in-person evaluation is about 11 percent more accurate than store-and-forward evaluation. In store-and-forward teledermatology, if one uses teledermoscopy, there is a 15 percent improvement in the accuracy.”

Dr. Armstrong reported on other findings from studies of teledermatology:

  • Patients are managed the same way whether they are treated in-person or with teledermatology — both store-and-forward and live-interactive.
  • The outcomes for patients are equivalent no matter what type of dermatology is practiced. This was determined in a randomized trial for the treatment of patients with atopic dermatitis.
  • Patients reported that teledermatology increased their quality of life and left them satisfied with the treatment model.

In the end, patients said they were pleased with both store-and-forward and live-interactive teledermatology because they offer flexibility, quick diagnosis, and convenience, Dr. Armstrong said.

“Teledermatology models are changing,” she said. “What we need to do is gather good evidence and make sure our decisions, our opinions and our policies are based on the evidence and not on our perception.”

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