Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.
Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego.
JAMA Dermatol. 2014 Jun;150(6):601-7. doi: 10.1001/jamadermatol.2013.7321.
Mobile teledermatology may increase access to care.
To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.
We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.
The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.
Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.
移动远程皮肤病学可增加获得医疗服务的机会。
确定博茨瓦纳哈博罗内的 HIV 阳性患者的移动远程皮肤病学是否可靠，并与面对面的皮肤科咨询相比，能够得出有效的评估结果。
设计、地点和参与者：在博茨瓦纳的门诊诊所和公共住院病房进行的横断面研究，纳入了 76 名年龄在 18 岁及以上的 HIV 阳性患者，这些患者患有皮肤或黏膜疾病，但尚未由皮肤科医生进行评估。
我们计算了测试-重测和组内一致性的诊断、诊断类别和管理的 κ 系数。我们还确定了每个诊断的敏感性和特异性。
对于主要诊断，测试-重测一致性的 κ 系数范围为 0.47（95%CI，0.35 至 0.59）至 0.78（0.67 至 0.88），诊断类别为 0.29（95%CI，0.18 至 0.42）至 0.73（0.61 至 0.84），管理为 0.17（95%CI，-0.01 至 0.36）至 0.54（0.38 至 0.70）。组内一致性的 κ 系数范围为 0.41（95%CI，0.31 至 0.52）至 0.51（95%CI，0.41 至 0.61），对于主要诊断，诊断类别为 0.22（95%CI，0.14 至 0.31）至 0.43（95%CI，0.34 至 0.53），管理为 0.08（95%CI，0.02 至 0.15）至 0.12（95%CI，0.01 至 0.23）。前 10 种诊断的敏感性和特异性范围分别为 0 至 0.88 和 0.84 至 1.00。
我们的结果表明，虽然在博茨瓦纳的 HIV 阳性患者中使用移动远程皮肤病学技术具有显著改善获得医疗服务机会的潜力，但需要进一步努力来提高该技术在该人群中的可靠性和有效性。
