August 14, 2019
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Cleveland Clinic teledermatology program helps patients gain access to providers

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A teledermatology program at the Cleveland Clinic resulted in a reduction in visits and diagnostic concordance comparable to previously reported findings, according to results published in Journal of the American Academy of Dermatology.

“These data suggest teledermatology may be particularly effective for evaluating acute, localized rashes, which the walk-in setting may attract,” Alok Vij, MD, of the department of dermatology at Cleveland Clinic, and colleagues wrote. “Teledermatologists may be more comfortable making virtual recommendations for such conditions.”

The store-and-forward teledermatology eConsult program was available at 25 walk-in clinics staffed by advanced practice providers who were instructed to use eConsults in place of nonemergent face-to-face dermatology consults.

A dermatology resident first reviewed the eConsults and then a consistent rotation of teaching faculty staffed the eConsults for relative-value-unit credit without insurance or monetary reimbursement, according to researchers.

From July 2014 to October 2017, 500 patients received 517 eConsults, the researchers reported.

The diagnoses of the teledermatologists were discordant with referring advanced practice providers in 71% of cases (n = 365), which resulted in recommended treatment changes in 60% of cases (n = 312), according to the study.

“The original treatment was appropriate in 119 cases, including 64 cases with discordant diagnoses,” the researchers wrote.

Teledermatologists recommended face-to-face visits before making a treatment recommendation in 86 eConsults.

In 28% of eConsults (n = 144), a face-to-face visit was recommended, the researchers reported.

Teledermatologists more often recommended a face-to-face visit for lesions (60%) than for rashes (25%), but they made management recommendations more often for rashes (66%) than for lesions (22%), the researchers found.

“Assuming that referring [advanced practice providers] used eConsult only when they would otherwise request [a face-to-face] visit, 71% of potential visits were avoided, even when including the [face-to-face] visits scheduled without recommendation,” Vij and colleagues wrote. – by Abigail Sutton

 

Disclosures: The authors report no relevant financial disclosures.