Chiru Maria-Roxana, Hindocha Sandip, Burova Ekaterina, Bejan Gabriel-Cristian, Manea Laura-Maria, Ghilencea Liviu-Nicolae
Department of Plastic Surgery, Bedford Hospital NHS Foundation Trust, Bedford MK42 9DJ, UK.
Department of Dermatology, Bedford Hospital NHS Foundation Trust, Bedford MK42 9DJ, UK.
J Pers Med. 2022 Jul 30;12(8):1258. doi: 10.3390/jpm12081258.
Although telemedicine emerged more than 100 years ago, the recent pandemic underlined the role of remote assessment of different diseases. The diagnoses of cutaneous conditions, especially malignant lesions, have placed significant stress on the fast-track pathway for general practitioners (GPs), dermatologists, and plastic surgeons. The aim of the study was to compare (pre- and during the pandemic) the ability of professionals to face the challenge.
The study was composed of 1943 consecutive patients (mean age 61.9 ± 18.3, 53.8% female) assessed by GPs, face-to-face (988 patients, 50.8%, between October 2019 and March 2020) and by virtual (video/photo) visits (955 patients, 49.2%, between March 2020 and October 2020) for skin lesions, and referred to secondary care via the two-week wait pathway for suspected skin malignancy.
The two groups had similar primary skin malignancies identification rates (24.3% vs. 22.1%, = 0.25). The virtual visits identified squamous cell carcinoma (SCC) better than face-to-face consultations ( = 0.04), but identified basal cell carcinoma less-well (BCC, = 0.02), whereas malignant melanoma (MM) was equally identified in the two groups ( = 0.13). There was no difference in the median breach time (days) of the two-week wait pathway (12, IQR = 6 vs. 12, IQR = 5, = 0.16) in the two groups. Virtual assessments (by GPs) of skin lesions suspected of malignancy, and referred via the two-week wait pathway, increased the probability of diagnosing SCC by 42.9% ( = 0.03), while for malignant melanomas, face-to-face and virtual consultations were alike ( = 0.12).
The equivalent outcomes in the management of skin cancers (SCC, MM) via the two-week pathway through virtual consultations and face-to-face appointments underline the role of telemedicine as a reliable alternative to face-to-face assessments.
尽管远程医疗在100多年前就已出现，但近期的疫情凸显了对不同疾病进行远程评估的作用。皮肤疾病的诊断，尤其是恶性病变的诊断，给全科医生（GP）、皮肤科医生和整形外科医生的快速通道带来了巨大压力。本研究的目的是比较（疫情前和疫情期间）专业人员应对这一挑战的能力。
本研究纳入了1943例连续患者（平均年龄61.9±18.3岁，53.8%为女性），这些患者由全科医生进行评估，其中988例患者（50.8%）于2019年10月至2020年3月期间接受面对面评估，955例患者（49.2%）于2020年3月至2020年10月期间通过虚拟（视频/照片）问诊评估皮肤病变，并通过两周等待途径转诊至二级医疗机构以怀疑皮肤恶性肿瘤。
两组原发性皮肤恶性肿瘤的识别率相似（24.3%对22.1%，P = 0.25）。虚拟问诊对鳞状细胞癌（SCC）的识别优于面对面咨询（P = 0.04），但对基底细胞癌（BCC）的识别较差（P = 0.02），而两组对恶性黑色素瘤（MM）的识别情况相同（P = 0.13）。两组两周等待途径的中位延误时间（天）无差异（12天，四分位间距 = 6天对12天，四分位间距 = 5天，P = 0.16）。通过两周等待途径转诊的疑似恶性皮肤病变的虚拟评估（由全科医生进行）使SCC的诊断概率提高了42.9%（P = 0.03），而对于恶性黑色素瘤，面对面和虚拟问诊相似（P = 0.12）。
通过虚拟问诊和面对面预约的两周途径在皮肤癌（SCC、MM）管理中的等效结果强调了远程医疗作为面对面评估可靠替代方案的作用。
