RAND/Harvard study shows teledermatology increases patient access to specialized skin care

PALO ALTO, CALIFORNIA (May 5, 2016) - Teledermatology significantly improved access to specialized skin care for a group of patients that traditionally has limited options, according to an independent study led by researchers at the RAND Corporation and Harvard Medical School's Department of Health. The findings appear in a JAMA Dermatology article published online May 4.

The researchers analyzed effects of a collaboration that began in 2012 between Direct Dermatology, a teledermatology service based in Palo Alto, California, and Health Plan of San Joaquin, a Medicaid managed care plan with nearly 300,000 enrollees in California.

"Results indicate that the introduction of teledermatology achieved the aim of increasing access to dermatologists in a large Medicaid managed care plan," the investigators said. "Patients among primary care practices engaged in teledermatology were more likely to have one or more visits with dermatologists, and the rate of visits with dermatologists also increased. After it was introduced, teledermatology served half of all enrollees who received any dermatology care. Among new enrollees, teledermatology served three-fourths of patients with any dermatology care in 2014."

"Patients covered by Medicaid have traditionally been one of the groups with limited access to dermatologists, but teledermatology is making it possible for patients to receive the care they need through a network of primary care physicians, teledermatologists and local dermatologists," said Dr. David Wong, CEO of Direct Dermatology (now DirectDerm). Wong was not involved in the study.

Wong said DirectDerm is not intended to take the place of local dermatologists, but to support them and to alleviate patient backlogs for both primary care doctors and skin-care specialists.

"We see ourselves as part of their network, contributing to the care they provide. In most cases, we can diagnose a condition and prescribe an effective treatment through teledermatology, resolving an issue for the patient, reducing physician load and lowering insurance costs because repeated follow-ups may not be needed. In situations where a biopsy or in-person exam is needed or when more aggressive treatment is required, we see the patients in person in our clinics or work with local primary care providers, dermatologists, and other physicians to expedite patient care," Wong said.

Wong added that all DirectDerm dermatologists are board-certified and received their training at top medical schools in the United States. In addition to providing teledermatology care, many practice in their local communities, teach at universities and conduct research.

Teledermatology is a general term for the use of telecommunications technology to exchange data for the diagnosis and treatment of skin conditions and diseases. In DirectDerm's approach, pictures of the area in question are taken with a digital camera, such as those on smartphones. The photos, along with a description of the problem and a medical history, are uploaded to DirectDerm's secure network, where they are reviewed by a dermatologist. Within two days, and often one, the patient receives a diagnosis and treatment recommendations, which may include over-the-counter medications or prescription drugs. Prescriptions are electronically sent to the patient's local pharmacy.

Wong said patients can access DirectDerm from virtually anywhere. If they need help with the photos or filling out the medical history questionnaire, assistance is available at participating primary physicians' offices and select retail pharmacy clinic locations.

"The wait to see a local dermatologist often ranges from two months to more than six months - especially in rural or underserved areas. This is too long because many problems will only get worse and some, like skin cancers, can become more difficult to treat," Wong said. "Teledermatology is all about easy access and accurate results."

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