Lee Celine Jessica, Evans Rebecca, Boyce Aaron
College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia.
Department of Dermatology, Townsville University Hospital, Douglas, Queensland, Australia.
Australas J Dermatol. 2024 Dec;65(8):e238-e247. doi: 10.1111/ajd.14371. Epub 2024 Oct 30.
The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care.
To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months).
Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period.
In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care.
Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.
澳大利亚农村和偏远地区皮肤科医生短缺的问题在昆士兰州北部尤为突出，该地区居民面临着皮肤癌和热带皮肤病的主要负担。存储转发远程皮肤病学（SAFT）被认为是改善农村社区皮肤科专科护理可及性的一种潜在解决方案。电子咨询（一种SAFT服务）于2022年在汤斯维尔更广泛的社区进行了试点。进行评估是为了确保更广泛的实施能够满足利益相关者的需求并改善患者护理。
评估在试点期间（长达9个月）汤斯维尔医院及卫生服务辖区内临床医生对电子咨询的看法和使用情况。
在临床医生使用电子咨询之前，对他们进行预参与访谈，评估他们对皮肤病的管理情况和服务期望。电子咨询转诊确定了临床医生之间该服务的病例特征、结果和使用情况。在试点期结束时，进行后参与访谈，评估临床医生的看法以及他们对该服务的建议。
分别有24名和17名临床医生参与了预参与访谈和后参与访谈，临床医生提交了38份转诊申请。该服务协助诊断和管理任何年龄组的非紧急皮肤疾病。临床医生总体上有积极的看法，并赞赏能够及时获得当地专家的建议。本研究表明，SAFT服务可以改善获得皮肤科专家意见的机会，并增加初级保健中皮肤病的管理。
建立用户积极参与的可持续远程皮肤病学服务对于提供可及的护理很重要。未来的研究可以调查涉及更多专家的类似SAFT模式，并评估长期成本效益。
