Bhargava Shashank, McKeever Charles, Kroumpouzos George
Department of Dermatology, R.D. Gardi Medical College, Ujjain, India.
Department of Dermatology, University of Panama Medical School and Social Security Hospital, Panama City, Panama.
Int J Womens Dermatol. 2021 Mar;7(2):217-223. doi: 10.1016/j.ijwd.2020.09.010. Epub 2020 Oct 12.
The spectrum and magnitude of changes in dermatology practice induced by the COVID-19 pandemic have not been adequately studied.
This study aimed to assess the immediate and long-term effects of the pandemic on dermatology practice on a large scale, including the clinical activity of participants, frequency and types of procedures used, and teledermatology (TD) use.
This web-based, global survey included 733 dermatologists. The primary outcomes are percentages of respondents providing in-person consultations, hospital service, and TD and performing procedures. Factors in logistic regression models that may influence the odds ratio (OR) for TD use during pandemic and for future use also were analyzed.
The percentages of respondents providing in-person consultations (46.6% vs. 100% before the pandemic) and hospital service (27% vs. 52.8% before the pandemic) as well as performing procedures (25.6% vs. 100% before the pandemic) decreased, whereas practicing TD increased three-fold (75.2% vs. 26.1% before the pandemic) during the pandemic ( < .001 for each). Practice location was associated with TD use during the pandemic and with its expected use in the future ( < .001 for both), with North American respondents indicating the highest use. TD use during the pandemic showed a positive correlation with TD use before the pandemic, performing procedures and, more specifically, with biopsies of suspicious pigmented lesions during the pandemic ( < .001 for each). TD use before the pandemic was the most powerful predictor of TD use during the pandemic (OR: 16.47; 95% confidence interval, 7.12-38.06). More than two third of participants (68.6%) expect to use TD in the future. The factor with the largest increase in OR on the expectation of future TD use was >1000 COVID-19 cases in the country (OR: 3.80; 95% confidence interval, 2.33-6.21).
This survey indicates a profound immediate effect of the pandemic on dermatology practice. The pandemic appears to have substantially contributed to an increased use of TD in the long run.
新型冠状病毒肺炎（COVID-19）大流行对皮肤科实践所带来变化的范围和程度尚未得到充分研究。
本研究旨在大规模评估该大流行对皮肤科实践的短期和长期影响，包括参与者的临床活动、所采用程序的频率和类型以及远程皮肤病学（TD）的使用情况。
这项基于网络的全球调查纳入了733名皮肤科医生。主要结局为提供面对面咨询、医院服务和TD以及实施程序的受访者百分比。还分析了逻辑回归模型中可能影响大流行期间及未来TD使用比值比（OR）的因素。
提供面对面咨询的受访者百分比（46.6%对比大流行前的100%）、提供医院服务的百分比（27%对比大流行前的52.8%）以及实施程序的百分比（25.6%对比大流行前的100%）均下降，而在大流行期间实施TD的比例增加了两倍（75.2%对比大流行前的26.1%）（每项均P<0.001）。执业地点与大流行期间TD的使用及其未来预期使用相关（两者均P<0.001），北美受访者的使用率最高。大流行期间TD的使用与大流行前TD的使用、实施程序，更具体地说，与大流行期间可疑色素沉着病变的活检呈正相关（每项均P<0.001）。大流行前TD的使用是大流行期间TD使用的最有力预测因素（OR：16.47；95%置信区间为7.12 - 38.06）。超过三分之二的参与者（68.6%）预计未来会使用TD。在对未来TD使用的预期中，OR增加幅度最大的因素是该国COVID-19病例数>1000例（OR：3.80；95%置信区间为2.33 - 6.21）。
这项调查表明大流行对皮肤科实践产生了深远的短期影响。从长远来看，大流行似乎在很大程度上促使了TD使用的增加。
