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Quality among direct-to-consumer dermatology websites varies

Direct-to-consumer telemedicine websites for dermatology vary in terms of skin disease diagnosis and treatment, and researchers raised concerns that regularly using these services may lead to fragmented, low-quality care, according to recent research published in JAMA Dermatology.

Jack S. Resneck Jr . , MD, professor and vice chair in the department of dermatology and Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, and colleagues received data on 62 clinical encounters across 16 direct-to-consumer (DTC) websites between February and March. Within these encounters, 68% of patients were assigned a clinician without a choice, and there were no questions about identification, use of pseudonyms and falsified photographs. Clinician licensure was disclosed in 26% of consults, with some clinicians having international licensure instead of being licensed by the state of California.

Regarding history, diagnosis and treatment, 23% of clinicians asked for the name of a PCP, and 10% of clinicians offered to send records. In 77% of encounters, there was a diagnosis or likely diagnosis offered; of these encounters, 31 clinicians ordered prescription medication, with 10 clinicians providing relevant adverse events and six clinicians offering pregnancy risks, according to the investigators.

While clinical encounters were successful when photographs alone were adequate, the researchers said, the diagnosis was poor when basic additional history elements, including fever, hypertrichosis and oligomenorrhea, were required. Specifically, diagnoses such as secondary syphilis, polycystic ovarian syndrome, eczema herpeticum and gram-negative folliculitis were frequently missed due to clinicians not asking basic history questions. When treatments were offered, Resneck and colleagues said treatments sometimes contradicted existing guidelines.

“We believe that DTC telemedicine can be used effectively, but it is best performed by physicians and team members who are part of practices or regional systems in which patients already receive care,” Resneck and colleagues wrote. “This allows telemedicine clinicians to view a patient’s existing medical records, communicate with existing health care team members, provide in-person follow-up when needed, and be accountable for the care they deliver.” – by Jeff Craven

Disclosure: Resneck reports serving on the AMA Board of Trustees and on the Telemedicine Task Force of the American Academy of Dermatology Association. Please see the full study for a list of all other authors’ relevant financial disclosures.