Is Telemedicine Suitable for Patients with Chronic Inflammatory Skin Conditions? A Systematic Review
Wynanda A. van EnstYing Chao WengSophie A. C. WantenMarieke M.B. SeygerEwout M. BaerveldtB.W.M. ArentsE.M.G.J. de JongJ. M. P. A. van den Reek
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Abstract:
Telemedicine, the provision of remote healthcare, has gained prominence, accelerated by the COVID-19 pandemic. It has the potential to replace routine in-person follow-up visits for patients with chronic inflammatory skin conditions. However, it remains unclear whether telemedicine can effectively substitute in-person consultations for this patient group. This systematic review assessed the effectiveness and safety of telemedicine compared with traditional in-person care for chronic inflammatory skin diseases. A comprehensive search in various databases identified 11 articles, including 5 randomized controlled trials (RCTs) and 1 clinical controlled trial (CCT). These studies evaluated telemedicine’s impact on patients with psoriasis and atopic dermatitis, with varying methods like video consultations and digital platforms. The findings tentatively suggest that telemedicine does not seem to be inferior compared with in-person care, particularly in terms of condition severity and quality of life for patients with chronic inflammatory skin diseases. However, these results should be interpreted with caution due to the inherent uncertainties in the evidence. There are indications that telemedicine can offer benefits such as cost-effectiveness, time savings, and reduced travel distances, but it is important to recognize these findings as preliminary, necessitating further validation through more extensive research.Keywords:
Teledermatology
Telehealth
Pandemic
Teledermatology is the delivery of specialist dermatological services at a distance. It has become possible because of technological advances in digital imaging and telecommunications. Consultations may be “interactive” using video-conferencing equipment or “store-and-forward” using prerecorded text and images. The best method to deliver teledermatology services is unknown. Studies were designed to determine (a) if it was possible to diagnose and manage skin diseases using video-conferencing equipment, (b) if teledermatology was acceptable to patients and medical practitioners, and (c) whether it offered any economic advantages. We have also compared interactive and store-and-forward techniques. The trials were conducted in collaboration with the Institute of Telemedicine & Telecare, Queen’s University, Belfast, as part of the UK Teledermatology Trials. The trials have involved more than 300 teledermatology consultations. Having established that a diagnosis can be made in more than two-thirds of the cases, the majority of video consultations have resulted in satisfactory management, with only small numbers of patients requiring face-to-face review. Teledermatology is generally popular with patients and can save them considerable time and money. Routine clinics continue in three centers. We have found that effective store-and-forward teledermatology requires very good images and comprehensive historical referral data.
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Teledermatology is essentially "dermatology at a distance", using one of many communication technologies to expand the reach of a dermatologist to those in need of their specialized knowledge. Most international teledermatology is store-and-forward in nature, a method in which images are stored on a computer and then transmitted electronically to a consulting dermatologist. This system is more convenient and less costly than real-time teledermatology. This review will focus on several of the store-and-forward teledermatology systems being developed and utilized successfully internationally. This discussion of "who" is practicing teledermatology is not comprehensive, but attempts to show some of the breadth of teledermatology practice around the world, including government national health plans, commercial endeavors, and charitable work by individuals and institutions. The goal in many instances is to provide better health outcomes through increased access, efficiency, and/or cost-effectiveness. More studies ultimately need to be conducted to develop a more comprehensive and sustainable model for teledermatology.
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Teledermatology and smartphone mobile applications have been at the forefront of advances in the screening and management of patients with skin lesions over the past decade. The Spanish teledermatology network, established in 2004 in the area surrounding the dermatology clinic in Seville, has now managed over 50,000 teleconsultations and has led to validated improvements in waiting times for referral and surgery, allowed patients to be treated in local settings, and improved the early diagnosis and initial prognosis of patients diagnosed with melanoma. Both teledermatology and smartphone mobile applications can be used as training tools to improve the diagnostic skills of physicians and dermatologists. They can also serve as rapid and reliable methods to prioritize patient care and ensure that specialized services and treatments are accessible regardless of patient circumstances.
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Teledermatology is a developing application of telemedicine. Studies and reviews regarding diagnostic accuracy, efficacy, and feasibility of teledermatology applications have been published in the literature. There are two main methods of teledermatology technology to use: store-and-forward and real-time videoconferencing. Teledermatology is a proven, effective diagnostic tool for skin lesions.
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Dermatologic surgery and aesthetic dermatology are rapidly emerging and expanding specialties in India. However, dermatologists practicing surgeries and aesthetics in India represent a highly selected group and are mostly confined to metros. Dermatologists in the peripheral and remote regions need to reach these specialists for the benefit of their patients and teledermatology is an invaluable tool for this purpose. Video-conference, store and forward, Satellite communication, Hybrid teledermatology, mobile teledermatology, Integration model, nurse-led teledermatology, teledermatology focusing difficult-to-manage cases, screening and triage services are the various teledermatology services developed to suit the needs of dermatology care from a distance. Types of teledermatology service, pattern of net work connectivity and purpose of dermatology service are the three cardinal parameters for management of the dermatoses from a distance. This article reviews the literature, and analyzes the possible options available for a teledermatosurgery practice.
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Teledermatology is in essence an application of clinical telemedicine that deals with the practice of dermatology via the latest communication and information technology. As with other telemedicine applications, the goal is to provide the highest quality of dermatologic care more efficiently by moving patient information rather than the patient. Teledermatopathology, on the other hand, is a nonclinical telemedicine application specifically relating to diagnosis of cutaneous histologic specimens. There are numerous articles evaluating diagnostic concordance of teledermatology. However, because of a lack of a "true" gold standard, most published studies have compared diagnostic capabilities of teledermatology to our traditional face-to-face evaluations. Although the diagnostic correlation varies from study to study, most experts agree that Store and Forward and real-time video teleconferencing teledermatology is as clinically effective as a face-to-face consultation, which is less than 100% accurate. Teledermatopathology is showing similar potential, but because of the limitations on sampling error and the high cost of the alternative, robotic remote telepathology units, its acceptance into our daily practice has been delayed. This article focuses mainly on Store and Forward Teledermatology given its significant advantage and reviews the literature on teledermatology and teledermatopathology's diagnostic concordance and acceptance.
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