Teledermatology concordant with in-person visits for diagnosis, treatment decisions

Concordance between teledermatology visits and in-person dermatology visits was reported for diagnostic and treatment decisions, according to a study.

“Patient outcomes are improved when dermatologists provide inpatient consultations,” Colleen K. Gabel, BS, of the department of dermatology at Massachusetts General Hospital, Boston, and colleagues wrote.

However, because inpatient access to dermatology services may be limited, Gabel and colleagues saw an opportunity to gain further understanding of how teledermatology can fit into current treatment paradigms. There is limited understanding about whether dermatologists can accurately make diagnoses and other treatment decisions in patients using telemedicine. The use of clinical data that were not generated by a dermatologist also makes these diagnoses particularly challenging, according to the researchers.

In the prospective study, they aimed to evaluate teledermatology as a tool for diagnosing disease and managing consultations at a large urban tertiary care center. There were 41 consultations included in the analysis. Documentation and photographs from internal medicine were used for the consultations. The study also included a survey of 27 dermatology hospitalists.

The primary endpoint of the study was inter-rater agreement.

Results showed “substantial agreement” between in-person visits and televisits when diagnoses included a differential diagnosis (median = 0.83).

“Substantial agreement” between in-person visits and teledermatology was also observed when decisions involved laboratory evaluation (median = 0.67), while “moderate agreement” was observed when biopsy decisions were involved (median = 0.43), according to the findings.

“Almost perfect agreement” was reported for imaging (median = 1.0) and treatment (median = 1.0) decisions.

However, no agreement was observed for follow-up planning (median = 0.0).

Other findings indicated that the researchers observed no association between the quality of the raw photograph and either the primary plus differential diagnosis or the primary diagnosis alone.

The experience level of the teledermatologist carried no association with diagnostic concordance or parameters pertaining to imaging, lab evaluations or decisions to pursue biopsy. In addition, dermatologists conducting televisits reported feeling uncomfortable with the approach about half of the time. The researchers attributed this discomfort to the novelty of telemedicine in the specialty.

Selection bias may limit the generalizability of the findings, as may the single-center nature of the study.

“Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation and management decisions,” the researchers wrote.