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Benefits Found for Telemedicine in Diagnosis, Disease Mgmt

April Armstrong (University of California, Davis)

April Armstrong (University of California, Davis)

Dermatologists in the University of California at Davis Health System that use videoconferencing technology, have found live interactive consultations can improve clinical outcomes for patients from beneficial changes in medical diagnosis and disease management that otherwise might not occur. Their findings appear in the current issue of the journal Archives of Dermatology (paid subscription required).

The team led by April Armstrong of UC Davis (pictured left) investigated the efficacy of live video consultations to provide patient care from a distance. They conducted a retrospective analysis of 1,500 patients who were evaluated via live interactive teledermatology at UC Davis between 2003 and 2005. The researchers compared diagnoses and treatment plans between the referring physicians and the teledermatologists. In the researchers’ analysis, patients with 2 or more teledermatology visits in a one-year period were assessed, including differences in diagnosis, disease management, and clinical outcomes.

Telemedicine is experiencing increased use in geographically distant regions and other medically underserved communities, say the researchers. One telemedicine method in dermatology involves image files that are stored and forwarded to a dermatologist for review at any time. Another method is live, interactive video sessions that enable real-time conversation among patients, referring physicians, and specialists. These interactive sessions enable clinicians to clear up questions about a patient’s health history as well as capture additional digital images if more clinical information is needed.

The results show that compared with diagnoses and treatment plans from the referring physician alone, nearly 70 percent of patients in the 1,500 teledermatology consultations resulted in diagnostic changes. Those changes in diagnoses included identifying benign lesions where malignant ones had been diagnosed by a primary-care provider, and diagnosing a malignancy for diseases such as basal cell carcinoma after an initial, primary-care diagnosis of benign cell growth.

The team found the live consultations likely resulted in improved diagnostic accuracy and more effective treatment plans, with each teledermatology follow-up visit associated with better odds of improved clinical outcomes. Patients receiving a changed diagnosis had better chances of clinical improvements compared to patients whose diagnoses remained unchanged.

The consultations also resulted in nearly all patients (98%) receiving recommendations via teledermatology to change the way patients managed their skin diseases. Those changes included dermatologist recommendations to begin or end a medication, to modify the dosage or delivery of a medication, and to undergo additional lab tests or cultures.

Live interactive technology says Armstrong, “enables us to see the skin problems, and we can have real-time discussions with patients and their providers as if we were in the room together. Our study confirms that it is an effective tool to improve patient outcomes.”

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