Telemedicine Brings Dermatology to Underserved Populations

Troy Brown, RN

May 05, 2016

Primary care practices that offer teledermatology had a 64% rise in the fraction of patients who saw a dermatologist compared with 21% in practices that do not offer teledermatology, according to an analysis of California Medicaid claims data.

"This particular model, and teledermatology in general, offer promise for other Medicaid plans that struggle with meeting the specialty care needs of traditional as well as new enrollees," Lori Uscher-Pines, PhD, RAND Corporation, Arlington, Virginia, and colleagues report in an article published online May 4 in JAMA Dermatology.

The researchers analyzed claims data from the Health Plan of San Joaquin, a California Medicaid plan that began covering teledermatology in April 2012, to compare teledermatology and in-person dermatologist services between primary care practices that did and did not offer teledermatology.

Access to dermatologists in the United States is uneven, as there is a shortage of dermatologists, combined with geographic misdistribution. For example, San Joaquin, California, has only 1.2 dermatologists per 100,000 population compared with the national average of 3.6 per 100,000 population.

Of the 382,801 enrollees from 2012 to 2014, 8614 patients (2.2%) saw a dermatologist at least once, and 48.5% of those who saw a dermatologist received teledermatology care.

Among the 1947 newly enrolled Medicaid patients, 75.7% of patients (n = 1474) who visited a dermatologist received teledermatology care.

Compared with patients who had in-person dermatology appointments, those who used teledermatology were more likely to be aged younger than 17 years (2600 [58.7%] of 4427 vs 1404 [33.5%] of 4187; P < .001), male (1849 [41.8%] of 4427 vs 1526 [36.4%] of 4187; P < .001), and nonwhite (2779 [66.4%] of 4188 vs 1844 [53.0%] of 3478; P < .001).

Teledermatology physicians were more likely to care for patients with viral skin lesions and acne, which combined accounted for 3405 (46.7%) of 7287 visits. In-person dermatologists were more likely to treat psoriasis and skin neoplasms of uncertain behavior, which combined accounted for 10,062 of 27,347 visits (36.8%).

"Although some common diagnoses occurred at in-person and teledermatology visits (eg, acne), in-person dermatology visits had higher rates of use for neoplasms and psoriasis and greater variation in diagnoses," the authors explain. "These patterns suggest that in-person dermatologists served many of the patients in greatest need, but teledermatology expanded access to a new group of enrollees with different demographics and different needs. Teledermatology also played an important role for the newly insured and may be a particularly attractive option for those having difficulty establishing a relationship with an in-person dermatologist."

The authors have disclosed no relevant financial relationships.

JAMA Dermatol. Published online May 4, 2016. Full text

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