key: cord-0831013-vy5c7411
authors: McGee, Jean S.; Reynolds, Rachel V.; Olbricht, Suzanne M.
title: Fighting COVID-19: Early Teledermatology Lessons Learned
date: 2020-06-15
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.06.027
sha: aacc7792cb887fed5288ee988411990d034e78a7
doc_id: 831013
cord_uid: vy5c7411

nan

COVID-19 has exacerbated the unequal access to medical care experienced by historically marginalized patient populations. 1 Early data demonstrate that the infection and death rates of predominantly black neighborhoods are 3-fold and 6-fold higher, respectively, than in predominantly white neighborhoods. 2 In response to the pandemic, both academic and private dermatology practices have quickly rolled out teledermatology service in an effort to continue access to care. Our study aimed to evaluate early practice patterns to identify any variations in the quality of and access to teledermatology service.

We randomly selected 274 teledermatology visits conducted during the month of April 2020 in the Department of Dermatology at Beth Israel Deaconess Medical Center. We reviewed each visit and extracted the following information including age, preferred language, diagnoses, disposition, visit type (telephone versus video), and visit duration. In addition, we randomly selected 250 in-person visits conducted during the month of February 2020 for a pre-pandemic comparison.

Prior to the pandemic, 32% of patients seen in person were older than 65 years and 7% of patients seen in person were non-English speaking, those defined as necessitating interpreter service (Table 1) . During the pandemic, 23% of patients seen in teledermatology were older than 65 years and 3% of patient seen in teledermatology were non-English speaking ( Table 1 ). The two most common diagnoses seen in teledermatology, other than a lesion of concern, were acne and dermatitis at 52% and 49% of total visits, respectively ( Table 2 ). Nearly all teledermatology visits with these diagnoses led to a recommendation for either discharge or follow-up via subsequent teledermatology visits. In contrast, 60% of teledermatology visits for evaluation of lesion(s) lead to a recommendation to follow up in person for re-evaluation and/or biopsy. Lastly, 75% of teledermatology visits with durations of 20 minutes or greater were conducted via telephone, rather than a video-based platform.

Limitations of this study include a small sample size, narrow scope, and a single institution. Our study suggests that elderly patients and non-English speaking patients may be experiencing unequal access to teledermatology care during the pandemic. Limited proficiency with technology, administrative burden to mobilize an interpreter service, and hesitancy on the part of patients to receive medical care via virtual platforms can all contribute to these findings.

Our study also suggests that teledermatology is best suited for acne and non-specific dermatitis. On the other hand, evaluations of lesion(s) may be best suited for in-person visits, as not to generate extra visits and unnecessary costs. Lastly, our study found that longer visits were more likely to be conducted by telephone, rather than video. This finding raises a possibility that visual cues may be an important consideration in teledermatology visits. Moving forward, we are tasked with creating a new practice model that is likely to be a hybrid of both in-person and teledermatology. Our early data support allocating teledermatology resources for certain diagnoses including acne and rashes. However, we need further studies to understand the operational and financial implications of having extra teledermatology visits for the evaluation of lesion(s). 

Racial, Economic and Health Inequality and COVID-19 Infection in the United States

COVID-19 and African Americans