Marson Justin, Ahmad Maham, Litchman Graham, Zakria Danny, Perkins Sara, Rigel Darrell
J Drugs Dermatol. 2023 Jan 1;22(1):101-104. doi: 10.36849/JDD.7169.
Studies suggest potential heterogeneity in telemedicine adoption with potential to exacerbate healthcare access inequity.
A pre-validated survey was electronically sent to a proprietary listserv of practicing US-based dermatologists. Results were stratified by when teledermatology was adopted. Chi-square and odds ratios (OR) with 95% confidence intervals (95%CI) were used to analyze categorical data while single-factor ANOVA with posthoc Tukey-Kramer was used for continuous data.
338 practicing US-based dermatologists completed the questionnaire. Academic/Government dermatologists were 4-times more likely (OR 4.08, 95%CI 2.37-7.03) to adopt teledermatology pre-COVID than private-practice dermatologists. Dermatologists with ≤10 years of experience were 1.8-times (OR 1.8, 95%CI 1.01-3.18) and 2.82-times more likely (OR 2.82, 95%CI 0.78-10.25) to adopt teledermatology pre-COVID-19 or at all, respectively, compared to dermatologists with ≥20 years of experience. Teledermatology adopters practiced more medical-dermatology (P<.0001) than non-adopters, who reported practicing more dermatologic surgery (P=.003; Tukey-Kramer α<.05) and dermatopathology (P<.0001; Tukey-Kramer α<.05). Pre-COVID-19 adopters were 4-times more likely (OR 4.69, 95%CI 1.46-15.07) to switch/incorporate live-interactive-only teledermatology (LI) post-COVID-19. Post-COVID-19 adopters were 6-times more likely (OR 6.09, 95%CI 3.36-11.06) to utilize LI than Pre-COVID-19 adopters. Pre-COVID-19 adopters use teledermatology for a larger proportion of patient visits than Post-COVID-19 adopters (19.6% v 10.4%, P<.0001), but also are 3.43-times more likely (OR 3.43, 95%CI 1.82-6.46) to report future decreases in usage.
Cross-sectional retrospective survey and potential response bias.
Current teledermatology usage may be a suitable tool for medical-dermatology-focused practices. Material hurdles still exist for procedurally-oriented practices and future studies should investigate these barriers to maximize equitable access to dermatological care. J Drugs Dermatol. 2023;21(1):101-104. doi:10.36849/JDD.7169.
研究表明，远程医疗的采用可能存在异质性，有可能加剧医疗服务可及性的不平等。
一份预先验证过的调查问卷通过电子邮件发送给美国执业皮肤科医生的一个专有邮件列表。结果根据采用远程皮肤病学的时间进行分层。卡方检验和95%置信区间（95%CI）的比值比（OR）用于分析分类数据，而单因素方差分析及事后Tukey-Kramer检验用于分析连续数据。
338名美国执业皮肤科医生完成了问卷。与私人执业皮肤科医生相比，学术/政府皮肤科医生在新冠疫情前采用远程皮肤病学的可能性高出4倍（OR 4.08，95%CI 2.37 - 7.03）。与有≥20年经验的皮肤科医生相比，经验≤10年的皮肤科医生在新冠疫情前或总体上采用远程皮肤病学的可能性分别高出1.8倍（OR 1.8，95%CI 1.01 - 3.18）和2.82倍（OR 2.82，95%CI 0.78 - 10.25）。采用远程皮肤病学的医生比未采用者更多地从事医学皮肤病学工作（P <.0001），未采用者报告更多地从事皮肤科手术（P =.003；Tukey-Kramer α <.05）和皮肤病理学工作（P <.0001；Tukey-Kramer α <.05）。新冠疫情前采用者在新冠疫情后转向/纳入仅实时互动远程皮肤病学（LI）的可能性高出4倍（OR 4.69，95%CI 1.46 - 15.07）。新冠疫情后采用者使用LI的可能性比新冠疫情前采用者高出6倍（OR 6.09，95%CI 3.36 - 11.06）。新冠疫情前采用者在患者就诊中使用远程皮肤病学的比例高于新冠疫情后采用者（19.6%对10.4%，P <.0001），但报告未来使用量减少的可能性也高出3.43倍（OR 3.43，95%CI 1.82 - 6.46）。
横断面回顾性调查以及潜在的应答偏倚。
当前远程皮肤病学的应用可能是专注于医学皮肤病学实践的合适工具。对于以手术为主的实践来说，仍然存在实质性障碍，未来的研究应调查这些障碍，以最大限度地实现皮肤科护理的公平可及性。《药物皮肤病学杂志》。2023；21(1)：101 - 104。doi:10.36849/JDD.7169
