Lopez-Villegas Antonio, Bautista-Mesa Rafael Jesus, Lopez-Liria Remedios, Perez-Heredia Mercedes, Hernandez-Montoya Carlos Javier, Gutierrez-Maldonado Maria Gador, Leal-Costa Cesar, Peiro Salvador
Laboratory for Research, Education and Planning in Critical and Intensive Care Medicine, CTS-609 Research Group, Poniente University Hospital, El Ejido-Almeria, Spain.
Economic-Financial Directorate, Alto Guadalquivir Hospital, Andujar-Jaen, Spain.
Public Health Nurs. 2025 Jan-Feb;42(1):419-434. doi: 10.1111/phn.13438. Epub 2024 Oct 15.
To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost-utility and cost per quality-adjusted life years (QALYs) to conventional dermatology consultations (face-to-face dermatology [F-F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients.
This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F-F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol-5D-5L (EQ5D-5L) questionnaire responses.
From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients' perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F-F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F-F/D group (p = 0.004).
This study shows that TD units in PC represent a significant cost-effective alternative to conventional hospital follow-up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients.
进行一项经济评估，以确定从公共卫生系统（PHS）和患者的角度来看，基层医疗（PC）中心的远程皮肤病学（TD）单元在成本效用和每质量调整生命年（QALY）成本方面是否可作为医院传统皮肤科会诊（面对面皮肤科[F-F/D]）的替代方案。
这是一项随机、对照、非盲法的多中心研究。在6个月期间，收集了450名患者的数据（TD组：225例 vs. F-F/D组：225例）。从两个角度分析了成本、生活质量和每QALY成本。QALY得分根据欧洲五维健康量表-5L（EQ5D-5L）问卷的回答进行估算。
从PHS的角度来看，TD组的每位患者成本降低了53.04%（p < 0.001）。TD组的医院就诊次数减少了72.43%（p < 0.001）。从患者的角度来看，TD使每位患者的成本降低了77.59%（p < 0.001）。F-F/D组的每QALY成本高出63.34%（p < 0.001）。TD组的总成本降低了56.34%（p < 0.001）。此外，TD组患者比F-F/D组患者多获得0.05个QALY（p = 0.004）。
本研究表明，PC中的TD单元是传统医院随访的一种具有显著成本效益的替代方案。为了加强PC中的TD，引入包含人工智能进行预诊断的远程会诊平台很重要。这将使全科医生和护士能够进行更准确的初步评估。对使用这些技术的医护人员进行全面培训也至关重要，以确保提供更高效和个性化的护理。公共卫生护士将从获得管理数字工具的新技能中受益，这将有助于早期识别皮肤病并减少不必要的专科转诊。这将优化资源并改善患者的响应时间。
