847 Teledermatology can optimize treatment of cutaneous disease in under-resourced clinics

Abstract

Teledermatology is a powerful tool that can increase access to care by connecting primary care providers (PCPs) to remote dermatologists, who can review photographs and provide specialist advice. Our research aims to assess the ability of teledermatology to improve care delivery to under-served patients, who may receive sub-optimal care for cutaneous disease from non-specialists. Using the American Academy of Dermatology program, AccessDerm, we provided asynchronous teledermatology consults to PCPs at a community health clinic serving uninsured Latino immigrants. Supporting teledermatology feasibility in this context, retrospective analysis of 131 consults revealed a 97% completion rate with rare failures due to photograph omission. We calculated a 37-hour mean teledermatology response time versus a 14-day appointment wait-time (p<0.00001). For 82 consults (65%), teledermatologists recommended a definitive plan of care without in-person evaluation, which increased availability of in-person appointments. In 15 cases, PCPs were given an interim treatment to initiate while awaiting appointments. Thus, teledermatology allowed more rapid care delivery in 97 cases (76%). In 72 cases, PCPs reported a tentative treatment plan prior to receiving a consult reply; teledermatologist-recommended management differed 82% of the time, emphasizing the importance of specialist input. Following teledermatologist recommendations would have changed the clinical course in 70% of all cases, permitting avoidance of sub-optimal outcomes including delayed care, under-treatment (e.g. missed infections), over-treatment (e.g. unnecessary antibiotics), and healthcare over-utilization (e.g. preventable ER visits). In sum, our results show teledermatology can accelerate care delivery and improve management of cutaneous disease in under-resourced clinics, including the potential to promote more judicious use of antimicrobial agents. Moreover, our research underscores the promise of teledermatology to increase access to specialty-level consultation and to reduce healthcare disparities for disadvantaged populations.