Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
School of Medicine, Keele University, Staffordshire, UK.
Syst Rev. 2024 Oct 12;13(1):258. doi: 10.1186/s13643-024-02655-5.
Although the number of teledermatology studies is increasing, not all variables have been researched in equal depth, so there remains a lack of robust evidence for some teledermatology initiatives. This review describes the landscape of teledermatology research and identifies knowledge gaps and research needs. This evidence map can be used to inform clinicians about the current knowledge about teledermatology and guide researchers for future studies.
Our evidence map was conducted according to the Campbell Collaboration checklist for evidence and gap maps. Eight databases were searched (CINAHL, Embase, PubMed, Scopus, Web of Science, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, and OpenGray), and only included systematic reviews of teledermatology involving humans published in English; while excluding non-systematic reviews (i.e., abstracts, conference proceedings, editorials, commentaries, or letters). From 909 records, 14 systematic reviews published between 2004 and 2022 were included. Our analysis focused on the systematic reviews' characteristics, dermatological conditions studied, rate of overlap and quality assessment of primary studies reviewed, and main findings reported.
Teledermatology was reportedly comparable with clinic dermatology and generally accepted by patients as a mode of care delivery for dermatological conditions. However, there are concerns about privacy, communication, completeness of information transmitted, familiarity with the technology, and technical problems. Healthcare professionals were generally satisfied with teledermatology but found telemedicine consultations longer than face-to-face consultations, and less confident in asynchronous teledermatology than conventional consultations. Teledermatology was reportedly more cost-effective than clinic dermatology; especially considering the distance traveled by patients, referral volume to teledermatology, and clinic dermatology costs. Although patients and providers are satisfied with teledermatology, face-to-face dermatology has higher diagnostic and management accuracy. Teledermatology was also used for training medical professionals. Regarding the validity and reliability of teledermatology outcome measures, no significant discussions were found.
COVID-19 spotlighted telemedicine in clinical care, and we must ensure telemedicine continually improves with robust research. Further research is necessary for establishing a standardized outcome set, enhancing accuracy, concordance, cost-effectiveness, and safety, comparing teledermatology with non-dermatologist care, examining its effectiveness in non-Western low and middle-income countries, and incorporating patient involvement for improved study design.
https://www.researchregistry.com/ (Unique Identifying Number: reviewregistry878).
尽管远程皮肤病学研究的数量正在增加，但并非所有变量都得到了同等深入的研究，因此仍然缺乏一些远程皮肤病学措施的可靠证据。本综述描述了远程皮肤病学研究的现状，并确定了知识空白和研究需求。该证据图可用于向临床医生介绍当前关于远程皮肤病学的知识，并为未来的研究指导研究人员。
我们的证据图是根据 Campbell 合作组织的证据和差距图清单进行的。我们检索了八个数据库（CINAHL、Embase、PubMed、Scopus、Web of Science、Cochrane 图书馆、JBI 系统评价和实施报告数据库以及 OpenGray），仅纳入了 2004 年至 2022 年期间发表的涉及人类的远程皮肤病学系统评价，排除了非系统评价（即摘要、会议记录、社论、评论或信件）。从 909 条记录中，纳入了 14 篇 2004 年至 2022 年期间发表的系统评价。我们的分析重点是系统评价的特征、研究的皮肤病状况、综述的原始研究的重叠率和质量评估以及报告的主要发现。
据报道，远程皮肤病学与皮肤科诊所相当，并且通常被患者接受为皮肤病护理的一种提供方式。然而，人们对隐私、沟通、传输信息的完整性、对技术的熟悉程度以及技术问题表示关注。医疗保健专业人员对远程皮肤病学总体上感到满意，但发现远程医疗咨询比面对面咨询时间长，对异步远程皮肤病学的信心不如常规咨询。与皮肤科诊所相比，远程皮肤病学被报道更具成本效益；特别是考虑到患者的旅行距离、远程皮肤病学的转诊量和皮肤科诊所的成本。尽管患者和提供者对远程皮肤病学感到满意，但面对面的皮肤病学具有更高的诊断和管理准确性。远程皮肤病学也用于培训医疗专业人员。关于远程皮肤病学结果测量的有效性和可靠性，没有发现重大讨论。
COVID-19 凸显了远程医疗在临床护理中的作用，我们必须确保远程医疗随着稳健的研究不断改进。需要进一步研究建立标准化的结果集，提高准确性、一致性、成本效益和安全性，比较远程皮肤病学与非皮肤科医生护理的效果，研究远程皮肤病学在非西方低收入和中等收入国家的有效性，并纳入患者参与以改善研究设计。
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