Keywords: Teledermatology, teleservices, dermatoscopy, family medicine physician
Teledermatology - the process of diagnosing dermatological problems, in the case of store-and-forward technology. It is a new method of diagnosing skin conditions in Lithuanian health care. Also it is a cost-effective tool to increase access of services for patients. Cost savings and benefits for the patients are especially pronounced in rural areas with long waiting time to dermatologist. This is the first project using store-and-forward technology to administrate teleservices in Lithuanian health care.
Are family medicine physicians (FMP) capable to provide teleservices?
What are the differences between diagnosis in dermatologist and qualified FMP’s reports?
A prospective pilot study was performed from November 2018 till January 2020. Subjects were 152 patients of the Family medicine department. They were consulted for skin check-up by qualified in dermatoscopy FMP and an advanced nurse practitioner. Patients’ information was managed by the store-and-forward technology. Skin lesions were photo-documented by digital dermatoscope. All data was sent to the dermatologist for consultation.
The included 152 patients were 11–88 years old. During 55 FMP’s visits 445 dermatoscopy images. The most common diagnosis was Seborrheic keratosis. 4 malignant skin tumor cases (1 malignant melanoma, 1 squamous cell carcinoma, 2 basal cell carcinoma) were diagnosed and completely treated during this study. FMP’s diagnosis compared to dermatologist’s reported diagnosis coincidence rate was 92.4%. Only for 7.6% lesions diagnosis between FMP and dermatologist were different. 43 (28.3 %) patients were referred for additional treatment to the dermatologist. The maximum time from registration to seeing a FMP for skin check-up was 4 days vs. dermatologist appointment 14-28 days. Approximate time until dermatologist report completed was 7 days.
Qualified in dermatoscopy FMPs are capable to provide teleservices. Our pilot study confirms the possibility of store-and-forward teledermatology in FMP practice is going to lead to a 71.7% reduction in referrals to a specialist.
Points for discussion:
How to improve establishment of teleservices in Lithuanian FMP practice?
How to make this skin examination model more accessible for adopting in primary care at booth rural and main areas of Lithuania?
Limitations: legislation basis for teleconsultation system, FMP qualification in dermatoscopy, no incentive payment to perform teleservices for FMP neither dermatologist. What we could do to resolve these limitations?