Dermatology Department, Hopital Nord , Marseille , France.
Department of Dermatology, Sainte Anne Military Hospital , Toulon , France.
Front Public Health. 2014 Nov 14;2:233. doi: 10.3389/fpubh.2014.00233. eCollection 2014.
In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.
We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.
A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7-21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26-3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.
The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.
2010 年，无国界医生组织（MSF）启动了一个远程专家系统，以改善其现场卫生工作者获得专业临床支持的机会。在医学专业中，皮肤病学是第二常见的远程专家咨询类型。本研究的目的是回顾该系统运行的头 4 年中的所有 MSF 远程皮肤病学病例。我们的假设是，审查将能够确定当前 MSF 远程皮肤病学系统中需要改进的关键领域。
我们对 2010 年 4 月至 2014 年 2 月期间，通过 MSF 平台由 MSF 现场医生转诊的所有皮肤病学病例进行了回顾性分析。我们根据一项针对所有参与这些病例的转诊医生和专家的调查进行了定量和定性分析。
系统共记录了 65 例临床病例，有 26 名专家参与了病例管理。提供专家首次回复的中位数延迟时间为 10.2 小时（IQR 3.7-21.1）。分配新病例的中位数延迟时间为 0.96 小时（IQR 0.26-3.05）。病例来源的三个主要国家是南苏丹（29%）、埃塞俄比亚（12%）和刚果民主共和国（10%）。治疗的主要主题是传染病（46%）、炎症性疾病（25%）和遗传性疾病（14%）。三分之一的用户完成了调查。专家和/或转诊医生提出的两个主要问题是缺乏关于患者随访的反馈以及转诊医生提供的临床细节和信息质量不足。
该系统显然为转诊医生提供了有用的服务，因为在 4 年的研究期间工作量稳步上升。尽管如此，用户调查和回顾性分析表明，通过提供最佳实践指南、使用预填转诊表格、在远程咨询后跟踪病例以及为临床摄影制定标准，MSF 远程皮肤病学系统可以得到改进。
