Messagier Anne-Laure, Blaizot Romain, Couppié Pierre, Delaigue Sophie
Dermatology Department, Centre Hospitalier Andrée-Rosemon, Cayenne, French Guiana.
EA 3593 Ecosystèmes Amazoniens et Pathologies Tropicales, University of French Guiana, Cayenne, French Guiana.
Front Public Health. 2019 Dec 19;7:387. doi: 10.3389/fpubh.2019.00387. eCollection 2019.
French Guiana is an overseas region of France on the north coast of South America and is mostly covered by tropical rainforest. Most human settlements are located along the coast while some settlements are scattered across the hinterland. In 2001, the French public health service launched a telemedicine pilot project between the main hospital in Cayenne and remote health centers in French Guiana to tackle healthcare access inequalities. The aim of the present study was to review dermatology cases of the French Guiana telemedicine network to assess the use of telemedicine in dermatology, in order to evaluate its usefulness and propose ways to improve the system. A retrospective study was conducted on all dermatology cases referred between July 2015 and December 2016 through the French Guiana platform. The Model for Assessment of Telemedicine (MAST) methodology was used as recommended by the European Union. A total of 254 cases were reviewed by dermatologists at Cayenne hospital over the 18-month study period, with a mean of 14 cases per month. All the 16 peripheral health centers used the telemedicine service during the study. In most cases (202/254, 80%), specialists provided a single diagnosis to the referrers. Infectious diseases represented the main reasons for requests (92/202, 46%) including 32% (29/92) of neglected tropical diseases like leprosy and cutaneous leishmaniasis. A total of 39% (100/258) peripheral centers answered the end-users' survey, and more than 85% found the answer delay was fast, the service useful and with an educational benefit. Overall, the accuracy of the diagnosis increased with the quality of the pictures provided, though the latter was good in only 60% (75/125) of the cases. Most patients for whom a teleconsultations has been required (234/254, 92%) have been managed in the peripheral health centers, while referring the patient to Cayenne was necessary for only 20/254 (8%). The telemedicine system in French Guiana appears to be an interesting solution to the lack of specialists and allowed a better access to specialized dermatology care for people living in the remote areas of this region.
法属圭亚那是法国位于南美洲北海岸的一个海外地区，大部分地区被热带雨林覆盖。大多数人类定居点位于沿海地区，而一些定居点则分散在内陆。2001年，法国公共卫生服务部门在卡宴的主要医院和法属圭亚那的偏远健康中心之间启动了一个远程医疗试点项目，以解决医疗服务获取不平等的问题。本研究的目的是回顾法属圭亚那远程医疗网络的皮肤科病例，评估远程医疗在皮肤科的应用，以评估其有用性并提出改进该系统的方法。对2015年7月至2016年12月期间通过法属圭亚那平台转诊的所有皮肤科病例进行了回顾性研究。采用了欧盟推荐的远程医疗评估模型（MAST）方法。在为期18个月的研究期间，卡宴医院的皮肤科医生共审查了254例病例，平均每月14例。在研究期间，所有16个外围健康中心都使用了远程医疗服务。在大多数情况下（202/254，80%），专家向转诊者提供了单一诊断。传染病是请求诊断的主要原因（92/202，46%），其中包括32%（29/92）的被忽视热带病，如麻风病和皮肤利什曼病。共有39%（100/258）的外围中心回复了最终用户的调查，超过85%的人认为回复延迟快、服务有用且有教育意义。总体而言，诊断的准确性随着所提供图片质量的提高而提高，不过只有60%（75/125）的病例图片质量良好。大多数需要远程会诊的患者（234/254，92%）在周边健康中心得到了治疗，而只有20/254（8%）的患者需要转诊到卡宴。法属圭亚那的远程医疗系统似乎是解决专科医生短缺问题的一个有趣方案，使该地区偏远地区的人们能够更好地获得专科皮肤科护理。
