Analysis of Teledermatology Consults in a County Hospital Setting (Preprint)

BACKGROUND Teledermatology consults are increasingly used by primary care providers for diagnosis and triage of skin conditions. However, there are few studies that analyze which conditions are most commonly sent for teledermatology consultation and which of those are most often referred for an in-person visit. OBJECTIVE We aim to examine teledermatology consults sent from primary care providers at a county hospital to identify common diagnoses that prompted use of the teledermatology system and determine which diagnoses required an in-person visit after teledermatology evaluation. METHODS A retrospective analysis was conducted based on 450 teledermatology consults from primary care providers at a county health system. Chart review was performed to identify the diagnoses made by the teledermatologist for each consult and which diagnoses prompted an in-person visit after teledermatology evaluation. RESULTS Our analysis captured 471 diagnoses. Seborrheic keratosis was the most frequent diagnosis (10.2%) prompting teledermatology consultation. Some diagnoses, such as non-melanoma skin cancer, actinic keratosis, and alopecia areata required an in-person visit after each teledermatology consult. Others, such as atopic dermatitis and lentigo, did not require an in-person visit and were able to be managed by teledermatology each time. Overall, 39.9% of diagnoses seen via teledermatology were referred for an in-person visit. CONCLUSIONS Teledermatology is valuable in managing many dermatologic conditions that present to primary care, while serving as an effective triage tool for more complex conditions or concern for malignancy. Conditions that required procedural management or involved the scalp also frequently required an in-person referral after TD evaluation. The lowest proportion of referrals for an in-person visit occurred in banal conditions without concern for malignancy.