Teledermatology- the solution or the problem

Avivit Golan Cohen, Naava Sadi Szyper, Ariel Yehuda Israel, Eugene Merzon, Shlomo Vinker

Keywords: telemedicine, dermatology, healthcare services

Background:

Teledermatology services are becoming increasingly common due to their ability to reduce the bureaucratic and financial burden on patients. However, the impact of increasing availability by adding new technology on the workload and efficiency of face-to-face traditional dermatology services has not yet been studied.

Research questions:

To evaluate the impact of teledermatology, mainly on the rate of follow-up visits, either remotely or face-to-face, and the potential for overuse.

Method:

This is a retrospective observational cohort study based on the database of Leumit Health Services and processed using MDclone© software. We compared all teledermatology visits (N=15,148) to all face-to-face dermatologist visits (N=248,545) between 2022 and 2023.
Variables: age, socio-geographic area, number of follow-up visits, sex, diagnoses, and treatment received.
Recommendations were mapped using text analysis software (NLP) after categorizing typical keywords according to a manually generated glossary.

Results:

The total number of dermatology visits increased by approximately 10%. Teledermatology was used by a younger population (average age 30.75±16.57 vs. 41.76±18.41, p<0.001). The distribution of sex and socio-geographic areas was similar. No specific diagnosis was recorded in 31% of Teledermatology visits, compared to only 2% in face-to-face visits. Some diagnoses were rarely recorded in Teledermatology visits but were relatively common in face-to-face visits, the most prominent being Seborrheic Keratosis (7% vs. 0%), Viral Wart (7% vs. 3%), and Nevus (6% vs. 1%).
In the 45 days following a Teledermatology visit, there were an average of 1.45 follow-up visits in Teledermatology and 0.86 face-to-face follow-up visits, compared to 0.48 follow-up visits in Teledermatology and 2.28 dermatologist follow-up visits when the initial visit was with a face-to-face dermatologist.

Conclusions:

Teledermatology increased supply and, consequently, demand and may contribute to increasing inequity. Such services should be introduced by efforts to navigate the right patient to the right service and reduce inequity.

Points for discussion:

How to evaluate the service in other ways?

How to make a better triage to patients that are using the service?

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