Department of Dermatology, University of Missouri, Columbia, MO, USA.
Missouri Telehealth Network, University of Missouri, Columbia, MO, USA.
J Telemed Telecare. 2024 Sep;30(8):1345-1352. doi: 10.1177/1357633X221147074. Epub 2023 Jan 18.
Suboptimal access to dermatologic care is dependent on patient location and insurance type. Although there have been attempts to address access issues, barriers to providing excellent dermatologic care to all patients at the right time still exist. The objective of this study was to investigate the clinical impact of Dermatology Extension for Community Healthcare Outcomes (ECHO) project participation on primary care providers' diagnostic and treatment tendencies and accuracy.
This was a retrospective cohort study constructed using Dermatology Extension for Community Healthcare Outcomes case and recommendation data from November 2015 to June 2021. The University of Missouri-based Dermatology Extension for Community Healthcare Outcomes specialty hub team offers regularly scheduled live interactive tele-mentoring sessions for primary care providers who practice in rural and underserved areas. 524 patient cases presented by 25 primary care providers were included in the analysis. Of those, 449 cases were included in diagnostic concordance, and 451 in treatment concordance analysis.
Less than 40% of all diagnoses were fully concordant with an expert panel. Over 33% of patients were misdiagnosed, and over 26% received partially correct diagnosis. Only 16% of all treatment recommendations were fully concordant with an expert panel.
Diagnostic and treatment accuracy of participants is low, and Dermatology Extension for Community Healthcare Outcomes platform ensured patients received correct diagnosis and treatment quickly. Although tele-dermatology models are effective, they continue to be underutilized. Dermatologists in practice and training should be encouraged to adopt innovative clinical educational models, like Dermatology ECHO, to expand access to dermatologic expertise for the most marginalized populations.
皮肤病学护理的服务获取不足取决于患者的位置和保险类型。尽管已经有解决获取途径问题的尝试，但在适当的时间为所有患者提供优质皮肤病护理的障碍仍然存在。本研究的目的是调查皮肤科社区医疗保健拓展（ECHO）项目参与对初级保健提供者诊断和治疗倾向及准确性的临床影响。
这是一项回顾性队列研究，使用 2015 年 11 月至 2021 年 6 月期间的皮肤科社区医疗保健拓展病例和建议数据构建。密苏里大学皮肤科社区医疗保健拓展专业中心为在农村和服务不足地区执业的初级保健提供者提供定期的现场互动远程指导会议。25 名初级保健提供者共提出 524 例患者病例，纳入分析。其中，449 例病例纳入诊断一致性分析，451 例纳入治疗一致性分析。
不到 40%的所有诊断与专家小组完全一致。超过 33%的患者被误诊，超过 26%的患者接受了部分正确的诊断。只有 16%的治疗建议与专家小组完全一致。
参与者的诊断和治疗准确性较低，皮肤科社区医疗保健拓展平台确保患者能够快速获得正确的诊断和治疗。尽管远程皮肤病学模型是有效的，但它们的利用率仍然很低。实践中的皮肤科医生和培训医生应鼓励采用创新的临床教育模式，如皮肤科 ECHO，为最边缘化的人群扩大获得皮肤科专业知识的途径。
