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Teledermatology success tied to primary care providers

The primary success of a teledermatology service at a Veterans Affairs Medical Center was reliant upon participation of primary care providers, according to recently published study results.

A retrospective medical record review was conducted of the Veterans Affairs patient record system to identify patients who had received and completed teledermatology services between Sept. 1, 2013, and April 30, 2013, at the Atlanta VA Medical Center. To determine whether teledermatologists’ recommendations were implemented, as well as turnaround times, researchers reviewed notes written by primary care providers (PCPs) and nurses. Prescribing medications, reassuring patients and conducting face-to-face appointments, including biopsies, were the possible recommendations.

There were 997 recommendations from 1,001 teledermatology referrals, with 241 (24.5%) coming from PCPs who completed a dermatology training course prior to the launch of teledermatology service at the Atlanta VA Medical Center. Medication was the most common recommendation (46.8%) and reassurance was the least common recommendation (17.5%). Eighty percent of all recommendations were followed by PCPs, with face-to-face appointment recommendations followed 98% of the time.

Recommendations for reassuring patients were not followed in 40.8% of cases and medication prescription recommendations were not followed 24.6% of the time.

PCPs who took part in the dermatology training course were not more likely to follow recommendations. One business day was the average turnaround time for the teledermatology referrals, with 66.8% of patients not needing a face-to-face appointment.

“The experience of the teledermatology service in the Atlanta VA Medical Center has been paradigm-changing for the veterans, with fast turn-around time and decreased need for [face-to-face] appointments,” the researchers wrote. “However, our study demonstrates the success of a teledermatology program relies heavily on the effective participation of [PCPs] … Our results reinforce previous studies’ conclusions that emphasized the importance of an infrastructure for teledermatology, including communication and tracking protocols, support staff, and well-defined roles for team members.” – By Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.