Teledermatology consults could change diagnosis, management

Consultations with a specialist via teledermatology changed diagnosis and management and could improve clinical outcomes for skin conditions, according to a new study.

Researchers at the University of California, Davis, performed a retrospective analysis of medical records for 1,500 patients evaluated by the university's teledermatology program from 2003 to 2005. Diagnoses and resulting treatments recommended by the patients' referring clinicians were compared with those determined by the teledermatologists. If patients had at least two teledermatology visits in a year, the researchers assessed for changes in outcomes. The study results appear in the January Archives of Dermatology.

The mean patient age was 35.2 years, with a range of 3 months to 88 years; 75.5% of patients were male and 24.5% were female. A mean of 15 days passed between referral and initial dermatology visit. The researchers found that teledermatology consultations changed diagnosis in 69.9% of patients and changed treatment plans in 97.7%. The three most common changes in diagnosis were from skin infection to primary inflammatory process, from malignant lesion to benign lesion, and from benign lesion to malignancy.

Three hundred thirteen patients had at least two teledermatology visits in a year, and of this group, 68.7% had clinical improvement. Number of teledermatology visits (P<0.001) and changes in diagnosis (P=0.01) and management (P<0.001) were significantly associated with better clinical outcomes in multivariate analysis.

The researchers cautioned that their results may not be generalizable to the entire U.S. population and that they could not precisely assess the effect of teledermatology on clinical outcomes because their trial was not randomized or controlled. However, they concluded that teledermatology consultations usually changed diagnosis and management and were associated with improved clinical outcomes. They predicted that the efficiency and ease of teledermatology will continue to improve along with improved technology.

“Continued research in clinical outcomes is necessary to ensure that this health care delivery modality is continually evaluated to deliver quality dermatologic care,” they wrote.