Pasadyn Selena R, McAfee John L, Vij Alok, Warren Christine B
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, USA.
Department of Dermatology, Cleveland Clinic, USA.
J Telemed Telecare. 2022 Apr;28(3):177-181. doi: 10.1177/1357633X20925269. Epub 2020 May 23.
Store-and-forward (SAF) teledermatology involves non-dermatologists sending clinical images to dermatologists. This improves patient care while reducing unwarranted face-to-face (FTF) specialist office visits. Comparisons between dermatologist diagnostic concordance with referring provider, treatment change recommendations, and FTF referrals have yet to be compared by type of provider and practice setting.
This retrospective chart review examined SAF teledermatology eConsults from four practice settings: Doctor of Medicine (MD)/Doctor of Osteopathic Medicine (DO) office visits, MD/DO walk-in clinics, nurse practitioner (NP)/physician assistant (PA) office visits and NP/PA walk-in clinics. The most recent 100 MD/DO office- and 100 NP/PA walk-in-referred patient charts were reviewed. There were only 71 NP/PA office and 47 MD/DO walk-in eConsults to review.
Teledermatologists agreed with referring provider diagnoses 50% of the time for MD/DO office visits, 29.8% for MD/DO walk-in clinics, 33.8% for NP/PA office visits and 34% for NP/PA walk-in clinics. Diagnostic concordance was significantly higher for eConsults from MD/DO office visits than MD/DO walk-in clinics ( = 0.021), NP/PA office visits ( = 0.035) or NP/PA walk-in clinics ( = 0.022). There were significantly more treatment changes recommended after walk-in eConsults than office visits (67 versus 44%, < 0.0001). FTF visits were recommended more after office visits than walk-in clinics (46 versus 27%, = 0.001). Overall, 21% (68/318) of patients ultimately attended FTF appointments.
SAF teledermatology improves diagnosis, reducing barriers to specialty care. Overall, potential FTF visit reduction was 79%. Expanding eConsult programmes, particularly in walk-in settings, and for use by NP/PAs or early career internists, may render dermatological care more expeditiously and avoid unnecessary FTF visits.
存储转发（SAF）远程皮肤病学是指非皮肤科医生将临床图像发送给皮肤科医生。这在改善患者护理的同时，减少了不必要的面对面（FTF）专科门诊就诊。皮肤科医生与转诊提供者之间的诊断一致性、治疗变更建议以及FTF转诊情况，尚未按提供者类型和执业环境进行比较。
这项回顾性图表审查研究了来自四种执业环境的SAF远程皮肤病学电子会诊：医学博士（MD）/骨病医学博士（DO）门诊、MD/DO随诊诊所、执业护士（NP）/医师助理（PA）门诊以及NP/PA随诊诊所。审查了最近100例MD/DO门诊和100例NP/PA随诊转诊患者的病历。可供审查的NP/PA门诊电子会诊仅有71例，MD/DO随诊电子会诊仅有47例。
远程皮肤科医生与转诊提供者诊断的一致性在MD/DO门诊为50%，MD/DO随诊诊所为29.8%，NP/PA门诊为33.8%，NP/PA随诊诊所为34%。MD/DO门诊电子会诊的诊断一致性显著高于MD/DO随诊诊所（P = 0.021）、NP/PA门诊（P = 0.035）或NP/PA随诊诊所（P = 0.022）。随诊电子会诊后建议的治疗变更显著多于门诊（67%对44%，P < 0.0001）。门诊后建议的FTF就诊多于随诊诊所（46%对27%，P = 0.001）。总体而言，21%（68/318）的患者最终接受了FTF预约。
SAF远程皮肤病学改善了诊断，减少了专科护理的障碍。总体而言，潜在的FTF就诊减少了79%。扩大电子会诊项目，特别是在随诊环境中，并供NP/PA或早期职业内科医生使用，可能会更迅速地提供皮肤病护理，并避免不必要的FTF就诊。
