719 A new free teledermatology platform effectively delivers specialist recommendations for uninsured Latino patients

Abstract

Access to specialist medical care in the U.S. is limited for economically disadvantaged patients and this worsens healthcare disparities for minority populations. To address this issue, the American Academy of Dermatology launched a new free teledermatology platform to deliver specialist advice to primary care providers (PCPs) in under-resourced clinics. Using the smartphone-based program, we offered consultations to PCPs in an urban community health clinic serving uninsured patients with a focus on Latino immigrants, who face various barriers to care. PCPs submitted patient histories and photographs, which were reviewed by remote dermatologists, who provided a diagnosis and plan of care or referred the patient to be seen in-person. To assess the effectiveness of the new platform, we retrospectively reviewed all consults (N=130) and found a completion rate of 98% with 3 incomplete cases due to failure to receive photographs; the mean time to the dermatologist reply was 7.6 hours. Importantly, we found in 63% (80/127) of completed cases, no in-person appointment was deemed necessary and a definitive plan of care was provided. Among the 37% (47/127) of consults referred for evaluation in clinic, 33 needed in-person examination due to diagnostic uncertainty while 14 required a procedure. For 24 deferred cases, teledermatologists gave an interim care plan while awaiting an appointment, thus accelerating delivery of actionable specialist recommendations in 82% of cases overall. We also assessed if the number of photographs was correlated with consult outcome, but found no significant difference between the mean number of uploaded images for diagnosed versus deferred cases (2.6 vs 2.1, p=0.10). In summary, we found the new free teledermatology platform provided rapid and reliable delivery of specialist-recommended advice to PCPs and obviated the need for in-person evaluation in the majority of cases. Moreover, our results demonstrate the potential of expanding teledermatology outreach to aid PCPs serving disadvantaged patients and to help mitigate healthcare disparities in dermatology.