Expansion Of Telemedicine Research Articles

Lessons from COVID-19 for Addressing Air Pollution Health Inequities: Time to Act

Air pollution health disparities can be reduced. The ‘triple jeopardy’ of air pollution exposures, health disparities and the COVID-19 pandemic presents a unique situation from which lessons we can learn. During the surge of the pandemic, there was evidence of reductions in ambient air pollutant concentrations during forced lockdowns, reductions in asthma hospitalizations and medication prescriptions, as well as expansion of telemedicine. It is time to use the accumulated knowledge to prepare for imminent COVID variants and future pandemics and implement informed changes to reduce air pollution health disparities. The lessons we have learned, when revisited and implemented, can be beneficial to all, particularly the most vulnerable among us. Such lessons are important starting points that can inform sustainable intervention strategies to reduce current air pollution and health disparities.

Accuracy of Three Commercial Home-Use Hemoglobin A1c Tests.

Background: The COVID-19 pandemic and the rapid expansion of telemedicine have increased the need for accurate and reliable capillary hemoglobin A1c (HbA1c) testing. Nevertheless, validation studies of commercially available products suitable for home use have been in short supply. Methods: Three commercial home-use capillary blood sample HbA1c tests (Home Access, CoreMedica, and A1cNow+) were evaluated in 219 participants with type 1 or type 2 diabetes (4-80 years years of age, HbA1c 5.1%-13.4% [32-123 mmol/mol]) at four clinical sites. Comparisons were made between HbA1c measurements from the commercial tests and paired venous samples for which HbA1c was measured at two central reference laboratories. The primary outcome was percentage of commercial HbA1c values within 5% of the corresponding reference values. Results: HbA1c values were within 5% (relative difference) of paired reference values for 82% of Home Access samples, 29% of CoreMedica samples, and 46% of A1cNow+ samples. Absolute differences were within 0.3% of the reference value for 75% of Home Access samples, 28% of CoreMedica samples, and 44% of A1cNow+ samples and exceeded 0.5% for 8%, 55%, and 37%, respectively. Conclusions: None of the commercial home-use HbA1c tests produced the National Glycohemoglobin Standardization Program goal of ≥90% measurements within 5% of a DCCT venous reference. However, the Home Access product performed substantially better than the CoreMedica or A1cNow+ products. Telemedicine is likely to persist as a mainstay of diabetes care well after the COVID-19 era. As such, accurate home-based HbA1c assessment represents an urgent need for the diabetes community.

Association Between Telemedicine Use in Nonmetropolitan Counties and Quality of Care Received by Medicare Beneficiaries With Serious Mental Illness

Access to specialty mental health care remains challenging for people with serious mental illnesses, such as schizophrenia and bipolar disorder. Whether expansion of telemedicine is associated with improved access and quality of care for these patients is unclear. To assess whether greater telemedicine use in a nonmetropolitan county is associated with quality measures, including use of specialty mental health care and medication adherence. In this cohort study, the variable uptake of telemental health visits was examined across a national sample of fee-for-service claims from Medicare beneficiaries in 2916 nonmetropolitan counties between January 1, 2010, and December 31, 2018. Beneficiaries with schizophrenia and related psychotic disorders and/or bipolar I disorder during the study period were included. For each year of the study, each county was categorized based on per capita telemental health service use (none, low, moderate, and high). The association between telemental health service use in the county and quality measures was tested using a multivariate model controlling for both patient characteristics and county fixed effects. Analyses were conducted from January 1 to April 11, 2022. Before the COVID-19 pandemic, telemedicine reimbursement was limited to nonmetropolitan beneficiaries. Receipt of a minimum of 2 specialty mental health service visits (telemedicine or in-person) in the year, number of months per year with medication, hospitalization rate, and outpatient follow-up visits after a mental health hospitalization in a year. In 2018, there were 2916 counties with 118 170 patients (77 068 [65.2%] men; mean [SD] age, 58.3 [15.6] years) in the sample. The fraction of counties that had high telemental health service use increased from 2% in 2010 to 17% in 2018. In 2018 there were 1.08 telemental health service visits per patient in the high telemental health counties. Compared with no telemental health care in the county, patients in high-use counties were 1.2 percentage points (95% CI, 0.81-1.60 percentage points) (8.0% relative increase) more likely to have a minimum number of specialty mental health service visits, 13.7 percentage points (95% CI, 5.1-22.3 percentage points) (6.5% relative increase) more likely to have outpatient follow-up within 7 days of a mental health hospitalization, and 0.47 percentage points (95% CI, 0.25-0.69 percentage points) (7.6% relative increase) more likely to be hospitalized in a year. Telemental health service use was not associated with changes in medication adherence. The findings of this study suggest that greater use of telemental health visits in a county was associated with modest increases in contact with outpatient specialty mental health care professionals and greater likelihood of follow-up after hospitalization. No substantive changes in medication adherence were noted and an increase in mental health hospitalizations occurred.

The role of telemedicine in minimally invasive gynecologic surgery.

Telemedicine has been available for decades but has had minimal use in the USA prior to the COVID-19 pandemic. We aim to educate readers on the benefits of telemedicine and provide insight from our experience to optimize care in this setting. The COVID-19 pandemic ushered in a massive increase in use of telemedicine, offering several advantages with comparable clinical outcomes. This review summarizes the recent vast expansion of telemedicine, describes the benefits specific to minimally invasive gynecologic surgery, and offers practical suggestions for maintaining a successful practice that incorporates both in-person and virtual experiences for patients, anticipating continued use of telemedicine beyond the end of the current public health emergency.

Synchronous Telemedicine Model in Urogynecology: Are Patients Willing to Continue Telemedicine in the Post-COVID-19 Pandemic Era?

ImportanceFollowing the recent expansion of telemedicine during the COVID-19 pandemic, this remote model of care in female pelvic medicine and reconstructive surgery will likely remain and continue to evolve.ObjectiveThis study was conducted to assess patients’ perceptions of and willingness to participate in a synchronous telemedicine visit beyond the COVID-19 pandemic for women with pelvic floor disorders.Study DesignWe conducted a cross-sectional study of women who completed a synchronous telemedicine visit from March 16 through May 22, 2020, at a urogynecology practice in an academic medical center. An electronic survey was distributed to women after all telemedicine visits. Demographic data, visit type, and survey responses were analyzed.ResultsTwo hundred two women received the survey, and 135 women completed it (response rate of 66.8%). The mean age of the respondents was 62.9 ± 16.4 years, and the 3 most common visit diagnoses were overactive bladder (43.7%), stress urinary incontinence (22.2%), and pelvic organ prolapse (21.4%). Most survey participants (88.9%) found that the quality of their telemedicine visits was better than expected, and 89.6% reported that they would like to continue telemedicine care. Our survey showed that 19.4% of women reported difficulty with technology.ConclusionsWe found that most women presenting for synchronous telemedicine urogynecology care had a positive visit experience and would continue to use telemedicine for their care. Further developmental work needs to be done on improving the ease of technology as well as availability of telemedicine in the care of women affected by pelvic floor disorders.

Impact of telehealth on health care in a multiple sclerosis outpatient clinic during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has precipitated expansion of telemedicine in outpatient management of chronic diseases including multiple sclerosis (MS). Studies conducted pre-pandemic, when telehealth was an alternative to in-person consultations, represent a different setting to current practice. The aim of this study was to assess the impact of telehealth on MS outpatient care in a tertiary metropolitan hospital in Melbourne, Australia during the COVID-19 pandemic. MethodFrom March-December 2020, patients and clinicians in the MS outpatient clinic were surveyed regarding their attitudes towards telehealth. Scores on the Expanded Disability Status Scale (EDSS) from telehealth and face-to-face appointments during the study period were compared to scores from face-to-face consultations before and after this period. Medical records were reviewed to compare management decisions made during telehealth versus face-to-face consultations. Diagnoses and treatment of MS relapses were compared to 2019. ResultsTelehealth was used in 73% of outpatient appointments. Patient satisfaction was generally high. Patients and clinicians preferred face-to-face consultations but were willing to use telehealth longer term. Overall, there were no significant delays in identifying patients experiencing disability worsening via telehealth, but EDSS increase was recorded in more face-to-face than telehealth appointments particularly for those with lower baseline disability. Disease-modifying therapy commencement rates were similar, but symptomatic therapy initiation and investigation requests occurred more frequently in face-to-face visits. Comparable numbers of MS relapses were diagnosed and treated with corticosteroids in 2019 and 2020. ConclusionsPatient satisfaction with telehealth was high, but both clinicians and patients preferred in-person appointments. Telehealth implementation did not lead to high rates of undetected disability worsening or undiagnosed acute relapses, but telehealth-based EDSS assessment may underestimate lower scores. Treatment inertia may affect some management decisions during telehealth consultations. Telehealth will likely play a role in outpatient settings beyond the COVID-19 pandemic with further studies on its long-term impact on clinical outcomes required.

Telemedicine Use in Refugee Primary Care: Implications for Care Beyond the COVID-19 Pandemic.

The expansion of telemedicine during the COVID-19 pandemic offers an opportunity to reach vulnerable refugee communities with limited access to healthcare; however, there are limited data on characteristics of refugee patients that are associated with telemedicine use. We examined primary care encounters between March 2020 and February 2021. We compared telemedicine encounters among refugee and non-refugee patients and examined patient characteristics associated with telemedicine use in refugee patients. Overall, refugees used telemedicine less (aOR = 0.59, p < .001). Among refugee patients, telemedicine encounters were more likely if the patient had hypertension or diabetes, had an activated patient portal, carried private insurance and spoke English as their primary language. Telemedicine may be a useful modality of care management for refugee patients who require many follow-up visits; however, language barriers remain a concern. This is important to consider as telemedicine efforts continue and are expanded.

Telemedicine and Otolaryngology in the COVID-19 Era.

The global Coronavirus disease 2019 (COVID-19) pandemic has resulted in an expansion of telemedicine. The purpose of this study is to present our experience with outpatient telemedicine visits within a single institution's Department of Otolaryngology during the initial COVID-19 era. Retrospective chart review. This was a single-institution study conducted within the Department of Otolaryngology at an urban tertiary care center. Data on outpatient visits was obtained from billing and scheduling records from January 6 to May 28, 2020. Visits were divided into "pre-shutdown" and "post-shutdown" based on our state's March 23, 2020 COVID-19 shutdown date. A total of 3447 of 4340 (79.4%) scheduled visits were completed in the pre-shutdown period as compared to 1451 of 1713 (84.7%) in the post-shutdown period. The proportion of telemedicine visits increased (0.7%-81.2%, P < .001). Overall visit completion rate increased following the shutdown (80.2%-84.7%, P < .001). Subspecialties with an increase in visit completion rate were general (76.9%-88.0%, P = .002), otology (77.4%-87.2%, P < .001), and rhinology (80.0%-86.2%, P = .003). Patients with Medicaid and Medicare had higher appointment completion rates following the transition to telemedicine visits (80.7%-85.7%, P = .002; 76.9%-84.7%, P = .001). Older age was associated with decreased appointment cancellation pre-shutdown (OR 0.994 [0.991-0.997], P < .001) but increased appointment cancellation post-shutdown (OR 1.008 [1.001-1.014], P = .015). Mean COVID-19 risk scores were unchanged (P = .654). COVID-19 has led to major changes in outpatient practice, with a significant shift from in-person to telemedicine visits following the mandatory shutdown. An associated increase in appointment completion rates was observed, reflecting a promising viable alternative to meet patient needs during this unprecedented time.

The benefit of telemedicine in obesity care.

It has been estimated that, by 2030, nearly 80% of adults in the United States will have pre-obesity or obesity. Despite the continued rise in obesity prevalence and the difficulty for many affected patients to lose weight and maintain lost weight, the use of guideline-supported treatments, including pharmacotherapy, intensive behavioral counseling, and bariatric surgery, remains low. There are many potential barriers to effective use of antiobesity treatments, including limited access to guideline-supported obesity care (often driven by practical challenges, geographic barriers, limited insurance coverage, and high cost of care) and a dearth of specialists and comprehensive treatment teams. Driven in part by the COVID-19 pandemic, the recent expansion of telemedicine offers unique opportunities to mitigate these factors. This review discusses the use of telemedicine to facilitate obesity treatment. Continued growth and utility of telemedicine for obesity care require further formative and experimental research to determine best practices, assess challenges for implementation, and evaluate long-term outcomes, as well as proactive policy changes to promote ongoing use of telemedicine beyond the COVID-19 pandemic.

Abstract NS3: Telemedicine Impact On Post-stroke Outpatient Follow-up In An Academic Healthcare Network

Introduction: The expansion of telemedicine associated with the COVID-19 pandemic has influenced outpatient medical care. The objective of our study was to determine the impact of telemedicine on post-acute stroke clinic follow-up. Methods: With this retrospective cohort study, we evaluated the impact of telemedicine in Emory Healthcare, an academic healthcare system of comprehensive (CSC) and primary stroke centers (PSC) in Atlanta, Georgia, on post-hospital stroke clinic follow-up. We compared the frequency of successful post-hospitalization follow-up in a centralized subspecialty stroke clinic among patients hospitalized before the local COVID-19 pandemic (January 1- February 28, 2020), during (March 1- April 30, 2020) and after telemedicine implementation (May 1- December 31, 2020). A comparison was made across network hospitals less than 1 mile (CSC) and 25 miles (PSC25) from the specialty stroke clinic. Results: Of the 553 ischemic stroke patients [median age 68 years (IQR 58-79), median NIHSS 4 (IQR 1-8)] discharged home or to a rehab facility during the study period, 241 (43.6%) had follow-up in the Emory Stroke Clinic (CSC=48%, PSC25=23%). Overall, 90-day follow-up increased from 31% before to 48% after telemedicine implementation. Similarly, telemedicine appointments increased from 19% to 72% of the follow-up visits. The increase in follow-up visits was modest among CSC patients, from 41% to 51% (p=0.16), relative to the increase among PSC25 patients (5.3% to 31%, p=0.002). Conclusions: Telemedicine implementation at an academic healthcare network successfully increased post-stroke discharge follow-up in a centralized subspecialty stroke clinic for hospitalized patients up to 25 miles from the clinic site. However, more work is required to facilitate follow up in the majority of patients.

Practical guidance for telemedicine use in neuro-oncology.

While the COVID-19 pandemic has catalyzed the expansion of telemedicine into nearly every specialty of medicine, few articles have summarized current practices and recommendations for integrating virtual care in the practice of neuro-oncology. This article identifies current telemedicine practice, provides practical guidance for conducting telemedicine visits, and generates recommendations for integrating virtual care into neuro-oncology practice. Practical aspects of telemedicine are summarized including when to use and not use telemedicine, how to conduct a virtual visit, who to include in the virtual encounter, unique aspects of telehealth in neuro-oncology, and emerging innovations.

Evaluation of mobile emergency service with the use of mixed method.

This is an evaluative study, with sequential explanatory mixed methods, aimed at evaluating the performance of the Brazilian Mobile Emergency Medical Service (SAMU) in the Grande ABC region, located in the state of São Paulo, Brazil. In the quantitative approach, an analysis of interrupted time series was performed to evaluate the immediate and gradual effects of the SAMU on hospital mortality due to acute myocardial infarction. The qualitative approach was conducted via semi-structured interviews and a thematic analysis was applied for the interpretation of the results, exploring the attitudes and values of the interviewees regarding the performance of SAMU in the Grande ABC region. Interrupted time series analysis showed a -0.04% reduction in the underlying mortality rate since SAMU implementation (95%CI: -0.0816; -0.0162; p-value = 0.0040) and a reduction in the mortality level, -2.89 (95%CI: -4.3293; -1.4623; p-value = 0.0001), both with statistical significance. To improve the robustness of the results, a control region was used, showing a statistically significant difference in the post-intervention result of -0.0639 (95%CI: -0.1060; -0.0219; p-value = 0.0001). The interviews revealed that the SAMU has the potential to intervene in the prognosis of transported cases, however, challenges related to the availability of beds, expansion of telemedicine, and continuous training of professionals for qualified emergency care in the event of a heart attack must be overcome. The results indicate that the studied intervention is part of a set of factors that, together, generate more conditions to achieve a better result.

ETHICAL AND LEGAL ASPECTS OF TELEMEDICINE APPLIED IN ORTHOPEDICS.

Due to the pandemic of COVID-19, many outpatient services were suspended, affecting hundreds of patients. As a result, several countries were forced to seek strategies to readapt their health systems, one of which was the expansion of telemedicine. Currently, telemedicine is used for several specialties, facilitating the treatment and follow-up of patients who have difficulty accessing it. Tele-orthopedics, telemedicine applied to the orthopedic specialty, allows orthopedic care to be offered to patients regardless of distance. By reducing travel time, waiting time, and costs, tele-orthopedics presents high patient satisfaction, allowing greater rehabilitation effectiveness after surgery and treatment compliance. There is much information in the current literature about telemedicine's legal and ethical aspects, but it is fragmented. This article aims to present a general explanation of these legal and ethical aspects, emphasizing tele-orthopedics. The ethical principles of autonomy, beneficence, non-maleficence and justice must be respected, as well the privacy and confidentiality during a teleconsultation. In this respect, orthopedic surgeons should be governed by traditional moral and ethical precepts. Still, they must also adapt to the new norms and laws regulating telemedicine use. Level of Evidence V: Expert Opinion.

Expansion of telemedicine during COVID-19 at a VA specialty clinic

BackgroundCOVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics. MethodsQuantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019–March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July–October 2020) with eight cardiology clinicians. ResultsAt the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p < 0.001). White (OR = 1.38, 95% CI:1.23–1.54), married (OR = 1.25, 95% CI:1.11–1.40), Veterans with other health insurance (OR = 1.19, 95% CI:1.06–1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR = 0.95, 95% CI:0.93–0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers. ConclusionsFindings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care. ImplicationsThe ability to rapidly transition from in-person to virtual visits can potentially assist with the continuity of care and management of chronic disease during infectious outbreaks and other major disasters that obstruct traditional care models.

Targets for improving disparate head and neck cancer outcomes in the low-income population.

Low‐income patients have worse head and neck cancer outcomes than those with high‐income. Yet, few targets have been identified to specifically improve outcomes in the low‐income population. Here, we conduct a review on the current literature on head and neck cancer outcomes in the low‐income population and identify targets for intervention. The degree of disparity is in the range of 20%‐90% worse overall survival in the low‐income population. Eliminating smoking would have the greatest effect on head and neck cancer mortality rates in the low‐income population. Additionally, access to oral cancer exams, assistance with transportation, and continued expansion of telemedicine would facilitate early diagnosis and timely treatment in patients who develop head and neck cancer.

Abstract 11134: The Feasibility of a Mail-Out 12-Lead ECG in a Pediatric Cardiac Electrophysiology Telemedicine Environment

Introduction: The COVID pandemic has driven an expansion of telemedicine. Telemedicine may be well-suited for pediatric electrophysiology (EP) outpatient consultations. However, an ECG forms part of the standard of care and there is no established strategy for performing a remote 12-lead ECG. Hypothesis: The use of mail-out 12 lead ECG in a pediatric cardiology telemedicine environment is feasible. Methods: Between Nov 2020 and June 2021, select patients with telemedicine EP consultation were offered a mail-out 12 lead ECG (QT Medical, Diamond Bar, CA). The equipment was sent to the patient’s home with technical support from both company and the cardiac clinic. ECGs were read and reported on the electronic health record. ECG quality was independently rated by 2 reviewers. Patient experience was recorded via survey (Qualtrics, Seattle, WA). Results: A total of 146 ECG recordings were transmitted in 31 patients [age 13 ± 5 years, 11 female (35%)]. Indications were prior arrhythmia [24 (77%)] or new cardiac symptoms [7 (23%)]. Prior arrhythmia diagnoses included WPW, paced rhythm, Brugada syndrome, ventricular tachycardia, complete heart block, long QT and monitoring of introduction of anti-arrhythmic medication. A median 3 (IQR 3-6) ECGs were recorded per patient. All patients had recordings suitable for clinical decision-making [21 had an ‘excellent’ recording (68%), 10 ‘good’ (32%), Figure 1]. Total time to perform the ECG (including app set up, application of device and recording transmission) was 46 ± 18 min. 77% found it ‘easy’ or ‘extremely easy’ to perform, and 80% were ‘confident’ or ‘moderately confident’ in the recording. Median travel time to clinic saved was 62 min (IQR 30-151 min). However, only 33% would prefer to perform the ECG at home rather than in clinic Conclusions: Clinically acceptable pediatric 12-lead ECGs may be performed at home by the patient and family. This technology may be considered for adjunctive use with telemedicine consultation in pediatric EP.

The Anticipation of Crime and Corruption Problems Due to the Expansion of Telemedicine: A Study Based on the Korea Medical Crime Investigation System.

The telemedicine system, which has been gradually introduced, has changed dramatically with the outbreak of COVID-19. Now, with the development of related laws and technologies, the introduction of telemedicine will be further accelerated, and like the advent of smartphones, this will become an unstoppable trend of the times. However, just as there are various crimes and corruption problems in the current health system, the introduction of telemedicine may bring other problems. Therefore, it is important to anticipate the types of corruption or crimes that will occur with the introduction of telemedicine. And based on these expectations, we will have an opportunity to properly prepare for the various problems associated with telemedicine.

P173 IMPROVING ACCESS TO HEALTHCARE THROUGH TELEMEDICINE IN AN UNDERSERVED ASTHMA POPULATION DURING THE COVID-19 PANDEMIC

Our pediatric pulmonology clinic caters to an underserved community (mostly African-American and Hispanic patients) with barriers to healthcare - such as transportation, poor literacy and language - which contribute to a baseline median “no-show” rate of 33% (January 2019 to March 2020). During the COVID-19 pandemic, families fearful of contracting the virus, missed or canceled in-person visits. Despite improved access via telemedicine patients continued to miss scheduled appointments. We aimed to reduce the no-show rate to 20% over 6 months through expansion of telemedicine. A team of physicians, front-desk staff and nurses educated families on telemedicine. We identified and addressed barriers to activating patient portal accounts, logging in during visits, and offered telemedicine appointments in lieu of in-person visits. We tracked monthly data. PDSA 1: We educated and enrolled patients on a patient portal with an inbuilt telemedicine module. By December 2020, patient portal activation increased from 20% to 85% and telemedicine appointments increased from a baseline of 0% to 75%. PDSA 2: We provided real-time troubleshooting for patients who experienced technical and language issues, and could not log in for telemedicine visits. PDSA 3: Due to excessive time spent during visits troubleshooting with patients, front-desk staff contacted patients prior to visits to address technical issues. We observed a sustained reduction in the no-show rate of 20% and lower. PDSA 4: Patients who missed in-person visits, were offered a telemedicine visit enabling more consistent patient access to healthcare. We reduced the overall no-show rate from a baseline of 33% to 18%.

Delays in Gender-Affirming Healthcare Due to COVID-19 Are Mitigated by an Expansion of Telemedicine

Kloer, Carmen I. BA; Lewis, Holly C. MD, PhD; Rezak, Kristen M. MD, FACS Author Information

Preferences Towards Electronically Exchanging Digital Images With Healthcare Providers Among US Adults.

Background: The rapid expansion of telemedicine, including teledermatology, during the COVID-19 pandemic has required both providers and patients alike to adapt to this digital transition. However, patient attitudes towards electronically shared images with their providers are poorly understood. To address this gap, we assessed digital image sharing preferences and associated determinants in a nationally representative sample.Methods: We analyzed pooled data from the Health Information National Trends Survey 4, Cycle 3 and 4. Digital image sharing preferences were compared by patient characteristics and beliefs via chi-square at a significance level of p<0.05, using sampling and jackknife replicate weights to develop nationally representative sample estimates and account for the complex survey design. P-values were adjusted for multiple comparisons when appropriate.Results: Among 6437 adults, 53.5% reported reluctance in electronically shared images and videos with providers. Greater aversion was observed among adults aged 75 or above (70.9%), retired (67.3%), and those with lower education (65.1%), lower annual income (60.9%), limited English proficiency (63.3%), distrust in health information from doctors (75.4%), and fair or poor health (60.4%).Conclusion: Patient hesitancy towards digital image sharing may present challenges for teledermatology adoption. Greater efforts may be needed to address the age and socioeconomic digital divide, multilingual telemedicine tools, and patient-physician dynamics to ensure vulnerable groups receive needed teledermatologic care.