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Video consults with dermatologists aid treatment

SUMMARY: Remote consultations with a dermatologist via high quality video improved the quality of care and outcome for the majority of patients, according to a new study, possibly paving the path for advancements in telemedicine.
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NEW YORK (Reuters Health) - After a live video consult with a dermatologist, almost every patient who'd previously been checked out by a primary care doctor had a change in their diagnosis or in their treatment, in a new study from California.

Researchers also found that having more "teledermatology" appointments meant it was more likely that a patient's condition would improve.

The findings are further evidence, experts said, that video conferencing with a far-away skin doctor might help people who live in remote areas where specialists are hard to come by -- or even those who have a dermatologist nearby, but have to wait a long time for an appointment.

"You can see the value in timely access to expert dermatological care, so that patients aren't given the wrong diagnosis and treated with a series of therapies that may not be helpful to them and may be costly," said Dr. Karen Edison, a dermatologist from the University of Missouri in Columbia who studies telemedicine, but was not involved in the new study.

Researchers said that while teledermatology is commonly used by the military for deployed soldiers, the concept hasn't seriously taken off among the general public -- but that may be changing.

"The patient really likes teledermatology because they get to see you and talk to you and have their questions answered," said Dr. April Armstrong, from the University of California, Davis School of Medicine in Sacramento, who worked on the new study.

"It really truly mimics face-to-face interaction," Armstrong told Reuters Health.

She said a typical video consult would last about 15 minutes, with a dermatologist on one end and the patient and primary care doctor on the other. The referring doctor's office would need to have a high-resolution camera for conferencing to give the dermatologist a detailed view of the patient's skin lesions.

To better understand how useful those types of conferences are, Armstrong and her colleagues collected the records of 1,500 patients who were evaluated through telemedicine by skin doctors at their university between 2003 and 2005.

They found that the video consult led to a change in diagnosis from the referring primary care doctor's decision in 70 percent of cases. Those changes included a diagnosis of psoriasis or eczema when primary care doctors had originally suspected a skin infection, or a change in the determination of whether or not lesions were considered cancerous.

Even more frequently, the consults led to a recommendation to start or stop taking a particular medication, or to change medication doses or the way a medication was given.

In total, there was a change in how a patient's condition was managed after almost 98 percent of video consults, the researchers reported in the Archives of Dermatology this week.

In a smaller group of 313 patients who had multiple teledermatology consults in a single year, Armstrong and her colleagues found that with each follow-up conference, patients were twice as likely to see improvement in their skin condition.

"Across the board, most people would say that of course an in-person exam is going to be better than any kind of telederm," said Dr. Erin Warshaw, chief of dermatology at the Minneapolis Veterans Affairs Health Care System, who didn't participate in the new research.

"But for those people in rural areas, the real question is whether telederm is better than no derm, or than derm provided by a primary care doctor."

The current study can't truly answer that, Warshaw told Reuters Health, because there was no "control" group of patients who were only treated through primary care, with no access to teledermatology.

The "vast majority" of dermatologists still don't do video conferencing, Edison said, and access is mostly limited to soldiers, prisoners and people in some underserved communities. One of the problems is that it's much less profitable than doing dermatology in person for the doctor, she said, and another is that not enough people are trained to do teledermatology during medical school or in continuing education courses for skin doctors.

Though live teledermatology may currently be inefficient for many doctors, researchers said insurance would typically cover the sessions.

Armstrong thinks the United States is on the cusp of a new generation with much more acceptance of telemedicine, which could improve treatment and health outcomes for people without easy access to dermatologists.

"Sometimes you really need an expert, and when primary care really needs an expert dermatologist, teledermatology is a nice way to ensure that patients have timely access," Edison said.

SOURCE: http://bit.ly/w48KCC Archives of Dermatology, online January 16, 2012.

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