Feasibility and cost of a telemedicine-based short-term plan for initial access in general dermatology in Andalusia, Spain

Ruben Barros-Tornay; Lara Ferrándiz; Francisco J Martín-Gutiérrez; Almudena Fernández-Orland; Amalia Serrano-Gotarredona; José M de la Torre; María D Conejo-Mir; Teresa Ojeda-Vila; Juan Márquez-Enríquez; Carlos Hernández; María J Ocaña; Juan M Herrerías-Esteban; David Moreno-Ramírez

doi:10.1016/j.jdin.2021.05.002

Feasibility and cost of a telemedicine-based short-term plan for initial access in general dermatology in Andalusia, Spain

JAAD Int. 2021 Jul 8:4:52-57. doi: 10.1016/j.jdin.2021.05.002. eCollection 2021 Sep.

Authors

Affiliations

¹ Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain.
² Dermatology Unit, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain.
³ Dermatology Unit, Hospital de Poniente, El Ejido, Spain.
⁴ Dermatology Unit, Hospital San Agustín, Linares, Spain.
⁵ Communication and Technology Service, Andalusia Health Council, Sevilla, Spain.

Abstract

Background: In developed countries, health care delivery in dermatology is hampered by the low availability of dermatologists.

Objective: To analyze the feasibility of a teledermatology-based action plan to provide initial dermatologic care in areas with low availability of dermatologists.

Methods: A cross-sectional study describing the feasibility and cost of a 12-month action plan based on a store-and-forward teledermatology (TD) connecting primary care centers and a TD center. Teleconsultations from patients complaining of any cutaneous condition were included. The primary outcome measure was the percentage of patients not referred to the local dermatologist.

Results: Among the total of 15,523 teleconsultations attended in the TD-based action plan, 3360 (21.65%) required a face-to-face visit with a local dermatologist. In 32.32% (n = 5017) of the cases, a therapeutic and follow-up plan report was issued. The most common conditions managed were melanocytic nevi (15.63%, n = 2426), followed by seborrheic keratosis (14.89%, n = 2312), and actinic keratosis (8.65%, n = 1342). The average response time was 14.52 days (95% CI 14.35-15.23). The additional total investment in this action plan was $142,681.01, with a unit cost of 9.20$/patient.

Limitations: Noncontrolled study.

Conclusions: Experienced dermatologists working with store-and-forward TD can deliver a fast and effective response in health care areas with access limitations.

Keywords: TD, teledermatology; accessibility; dermatology care; health care services; technology; teledermatology; telemedicine.