Dovigi Edwin, Lee Ivy, Tejasvi Trilokraj
Department of Dermatology, Rush University Medical Center, Chicago, Illinois, USA.
Pasadena Premier Dermatology, Pasadena, California, USA.
Telemed J E Health. 2022 Jan;28(1):115-120. doi: 10.1089/tmj.2021.0011. Epub 2021 Mar 25.
Background:The current coronavirus disease 2019 (COVID-19) pandemic has forced dermatology practices to rapidly adopt or expand teledermatology services. To date, teledermatology clinical practice guidelines (CPGs) have not been evaluated for quality. This may hinder the implementation and sustainability of high-quality teledermatology services. The objective of this study is to evaluate teledermatology CPGs by using a comprehensive, validated appraisal tool and provide actionable recommendations for improvement for future guideline developers.
Materials and Methods:A systematic literature search was performed to identify all CPGs published in teledermatology. Identified guidelines meeting inclusion criteria were scored for guideline quality by three researchers using the Appraisal of Guidelines and Research and Evaluation tool (AGREE II).
Results:Three guidelines met inclusion criteria, including guidelines published by the American Telemedicine Association, the British Association of Dermatologists, and the Australian College of Dermatologists and the University of Queensland. Each of these guidelines exhibited unique strengths and areas for improvement. Areas of strength include clear objective statements, stakeholder involvement, and clarity of presentation. Areas for improvement include rigor of guideline development, applicability, and editorial independence.
Conclusions:All guidelines were determined to be of sufficient quality for adoption based on AGREE scoring. Adoption of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) evidence appraisal framework would improve the rigor of development of each guideline. Administering and publishing questionnaires to assess financial competing interests and external review processes would shed more light on the presence and/or extent of author bias. One inherent limitation of CPG selection criteria is that large providers of teledermatology services, such as the United States Veterans Affairs, were not examined in this review. However, the results of this study provide actionable targets to improve the quality of the teledermatology CPGs examined in this study.
当前的2019冠状病毒病（COVID-19）大流行迫使皮肤科医疗机构迅速采用或扩大远程皮肤病学服务。迄今为止，远程皮肤病学临床实践指南（CPG）尚未进行质量评估。这可能会阻碍高质量远程皮肤病学服务的实施和可持续性。本研究的目的是使用一种全面、经过验证的评估工具来评估远程皮肤病学CPG，并为未来的指南制定者提供可操作的改进建议。
进行系统的文献检索，以识别所有发表的远程皮肤病学CPG。由三名研究人员使用指南评估与研究评价工具（AGREE II）对符合纳入标准的指南进行指南质量评分。
三项指南符合纳入标准，包括美国远程医疗协会、英国皮肤科医师协会以及澳大利亚皮肤科医师学会和昆士兰大学发布的指南。这些指南各有独特的优势和改进之处。优势领域包括明确的目标陈述、利益相关者的参与以及表述的清晰度。改进领域包括指南制定的严谨性、适用性和编辑独立性。
根据AGREE评分，所有指南的质量均足以采用。采用推荐分级评估、制定和评价（GRADE）证据评估框架将提高每项指南制定的严谨性。通过管理和发布问卷来评估财务利益冲突和外部评审过程，将更清楚地了解作者偏见的存在和/或程度。CPG选择标准的一个固有局限性是，本综述未对大型远程皮肤病学服务提供商，如美国退伍军人事务部进行研究。然而，本研究结果提供了可操作的目标，以提高本研究中所审查的远程皮肤病学CPG的质量。
