Dovigi Edwin, Kwok Elaine Yuen Ling, English Joseph C
Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612 USA.
Department of Pediatrics, McMaster University, Hamilton, ON Canada.
Curr Dermatol Rep. 2020;9(4):353-361. doi: 10.1007/s13671-020-00323-0. Epub 2020 Nov 12.
Telemedicine use in dermatology, termed "teledermatology", offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research.
Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated.
This systematic review is the first study to summarize the existing teledermatology implementation literature into well-defined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided.
The online version contains supplementary material available at 10.1007/s13671-020-00323-0.
在皮肤病学中使用的远程医疗，即“远程皮肤病学”，提供了一种具有成本效益的模式，以提高医疗保健效率和可及性。在2019年冠状病毒病（COVID-19）之前，只有少数皮肤科医疗机构将远程皮肤病学纳入其业务中。全面了解障碍和促进因素可能会推动远程皮肤病学的采用。实施科学框架提供了理论驱动的方法来评估影响远程皮肤病学实施的因素。本综述使用一个全面的实施科学框架来总结远程皮肤病学实施的障碍和促进因素，并评估现有研究的质量。
远程皮肤病学的技术特征（如用户友好性）和外部环境中的因素（如报销和法律考量）是最常被报道的障碍。现有的研究中没有使用全面的实施框架来识别影响远程皮肤病学实施的因素。许多纳入的研究在评估的五个研究质量指标中至少有两个指标存在偏倚风险。
本系统综述是第一项将现有的远程皮肤病学实施文献总结为来自全面实施科学框架的明确构建的研究。研究结果表明，未来的研究将受益于使用实施框架，以减少研究偏倚、提高结果的全面性、便于跨研究比较，并为实施障碍提供基于证据的解决方案。提供了有助于在未来研究中使用实施框架的工具、资源和建议。
在线版本包含可在10.1007/s13671-020-00323-0获取的补充材料。
