Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pediatr Dermatol. 2020 Nov;37(6):1106-1112. doi: 10.1111/pde.14226. Epub 2020 Aug 31.
BACKGROUND/OBJECTIVES: Long wait times for in-person appointments in pediatric dermatology can lead to delays in specialty care, additional health system touchpoints, patient and family dissatisfaction, poorer outcomes, and increased overall health care costs. Store-and-forward teledermatology may address these challenges and improve access to care in pediatric dermatology.
We describe a prospective, non-blinded cohort study with follow-up surveys conducted from March 1, 2018, to September 20, 2018. The study was conducted at a single center, in primary care and specialist settings. Patients included were <18 years old and received care at one of our affiliated primary care sites. Primary care providers submitted teledermatology consultations through a shared electronic medical record. A board-certified pediatric dermatologist evaluated each consultation; primary care providers conveyed recommendations to families.
Forty-three consultations for patients (23 male, 20 female; median age: 7 years [IQR: 2.4-12]) were entered by primary care providers. Median time from consult request to dermatologist initiating consult was 12.1 hours [IQR: 1.9-18.8]; median time to complete consult note was 7 minutes [IQR: 5-10.5]. Median time from primary care provider initially consulting to conveying teledermatology recommendations to families was 3 days [IQR: 1-5]. All but one consult (42/43, 98%) were completed in the intended workflow. Follow-up in-person visits with pediatric dermatologists occurred with 10/43 (23%) patients. In follow-up surveys, parents were 83% likely to recommend the service to family and friends. All primary care providers and dermatologists felt the service improved quality of care.
Provider-to-provider teledermatology consultation appears to be a feasible and acceptable method of providing care quickly and effectively to pediatric patients.
背景/目的：儿科皮肤科门诊预约等待时间长会导致专科治疗延迟、增加医疗系统接触点、患者和家属不满、治疗效果更差，以及整体医疗保健成本增加。存储转发远程皮肤病学可以解决这些挑战，并改善儿科皮肤科的就诊机会。
我们描述了一项前瞻性、非盲队列研究，从 2018 年 3 月 1 日至 2018 年 9 月 20 日进行了随访调查。该研究在一家单中心、初级保健和专科环境中进行。纳入的患者年龄小于 18 岁，在我们的一个附属初级保健机构接受治疗。初级保健提供者通过共享电子病历提交远程皮肤病学咨询。一名经过委员会认证的儿科皮肤科医生评估每个咨询；初级保健提供者将建议传达给患者家属。
初级保健提供者输入了 43 名患者的咨询（23 名男性，20 名女性；中位年龄：7 岁[IQR：2.4-12]）。从咨询请求到皮肤科医生开始咨询的中位时间为 12.1 小时[IQR：1.9-18.8]；完成咨询记录的中位时间为 7 分钟[IQR：5-10.5]。从初级保健提供者首次咨询到向患者家属传达远程皮肤病学建议的中位时间为 3 天[IQR：1-5]。除 1 例咨询（43 例中的 42 例，98%）外，所有咨询均按预期工作流程完成。有 10/43（23%）名患者进行了后续的皮肤科医生门诊就诊。在随访调查中，83%的家长表示愿意向家人和朋友推荐该服务。所有初级保健提供者和皮肤科医生都认为该服务提高了护理质量。
提供者对提供者的远程皮肤病学咨询似乎是一种快速有效为儿科患者提供护理的可行且可接受的方法。
