Trends in Teledermatology Utilization in the United States

Background Teledermatology is an effective health care delivery model that has seen tremendous growth over the last decade. This growth can be attributed to a variety of factors, including but not limited to an increased access to dermatologic care for those with socioeconomic or geographic barriers, a reduction in health care costs for both the patient and the physician, and the delivery of high-quality dermatologic care. However, the associated barriers include practice reimbursements, interstate licensing, and liability. Despite these apparent barriers, the emergence of COVID-19 afforded teledermatology a surge of demand and loosened regulations, allowing dermatologists to see higher volumes of teledermatology patients. In this paper, we analyzed the American Academy of Dermatology’s DataDerm registry teledermatology utilization and patient demographic trends throughout the COVID-19 pandemic. Objective The aim of this paper was to characterize national-level teledermatology demographic data in the setting of the COVID-19 pandemic. Methods National-level data were curated for all practices enrolled in the American Academy of Dermatology’s DataDerm registry from April 1, 2020, through June 30, 2021. Encounter utilization rates were collected for visit type (ie, teledermatology versus in person), sex, race, age, insurance provider, and location (ie, in state versus out of state). The aggregate total data, as opposed to individual encounter data, were collected. Results The proportion of women who utilized services via teledermatology (65,023/98,642, 65.9%) was greater than that of those who utilized in-person services (29,40,122/50,48,450, 58.2%). Non-White patients made up a higher percentage of teledermatology utilizers (8920/62,324, 15%) when compared with in-person utilizers (3,94,580/35,08,150, 11.7%). Younger patients (aged <40) contributed more to teledermatology service utilization (62,695/75,319, 83.2%) when compared with in-person services (13,29,218/33,01,175, 40.3%). Medicare was a larger payor contributor for in-person services (8232/1,53,279, 25.2%) than for teledermatology services (10,89,777/43,30,882, 5.4%). Utilization by out-of-state patients was proportionally higher for teledermatology services (19,422/1,33,416, 14.6%) compared with in-person services (5,80,358/1,38,31,400, 4.2%). Conclusions Teledermatology services may reach and benefit certain populations (female, younger patients, those with non-White racial backgrounds, and out-of-state patients) more so than others. These baseline demographics may also serve to highlight populations for potential future teledermatology outreach efforts. Conflict of Interest None declared.

Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review

HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people’s acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13–17, 18–24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.

Trends in Teledermatology Utilization in the United States (Preprint)

BACKGROUND Teledermatology is an effective health care delivery model that has seen tremendous growth over the last decade. This growth can be attributed to a variety of factors, including but not limited to an increased access to dermatologic care for those with socioeconomic or geographic barriers, a reduction in health care costs for both the patient and the physician, and the delivery of high-quality dermatologic care. However, the associated barriers include practice reimbursements, interstate licensing, and liability. Despite these apparent barriers, the emergence of COVID-19 afforded teledermatology a surge of demand and loosened regulations, allowing dermatologists to see higher volumes of teledermatology patients. In this paper, we analyzed the American Academy of Dermatology’s DataDerm registry teledermatology utilization and patient demographic trends throughout the COVID-19 pandemic. OBJECTIVE The aim of this paper was to characterize national-level teledermatology demographic data in the setting of the COVID-19 pandemic. METHODS National-level data were curated for all practices enrolled in the American Academy of Dermatology’s DataDerm registry from April 1, 2020, through June 30, 2021. Encounter utilization rates were collected for visit type (ie, teledermatology versus in person), sex, race, age, insurance provider, and location (ie, in state versus out of state). The aggregate total data, as opposed to individual encounter data, were collected. RESULTS The proportion of women who utilized services via teledermatology (65,023/98,642, 65.9%) was greater than that of those who utilized in-person services (29,40,122/50,48,450, 58.2%). Non-White patients made up a higher percentage of teledermatology utilizers (8920/62,324, 15%) when compared with in-person utilizers (3,94,580/35,08,150, 11.7%). Younger patients (aged &lt;40) contributed more to teledermatology service utilization (62,695/75,319, 83.2%) when compared with in-person services (13,29,218/33,01,175, 40.3%). Medicare was a larger payor contributor for in-person services (8232/1,53,279, 25.2%) than for teledermatology services (10,89,777/43,30,882, 5.4%). Utilization by out-of-state patients was proportionally higher for teledermatology services (19,422/1,33,416, 14.6%) compared with in-person services (5,80,358/1,38,31,400, 4.2%). CONCLUSIONS Teledermatology services may reach and benefit certain populations (female, younger patients, those with non-White racial backgrounds, and out-of-state patients) more so than others. These baseline demographics may also serve to highlight populations for potential future teledermatology outreach efforts.

The Evolution of Telehealth From Pre-COVID-19 Pandemic Through A Hybrid Virtual Care Delivery Model: A Pediatric Hospital’s Journey

The COVID-19 pandemic transformed care delivery and influenced telehealth adoption by rehabilitation professionals and their patients. The purpose of this paper is to describe a pediatric health system’s telehealth services pre-pandemic and how those services were scaled during the pandemic. A secondary aim is to provide a roadmap for the operational delivery of telehealth and rehabilitation services, including transition to a hybrid care delivery model. Findings suggested that telehealth can be rapidly scaled to address patient healthcare needs for an early intervention population during a pandemic. Telehealth use during the pandemic helped ensure continuity of care and likely reduced the risk of exposure to patients and staff to the virus. Benefits included enhanced access to care, and savings in time and money for families. Interestingly, as the pandemic declined, the use of telehealth services declined due to patient preference, with many families opting to request a return to in-person care.

Co-designing an Integrated Care Network With People Living With Parkinson’s Disease: From Patients’ Narratives to Trajectory Analysis

An integrated care model for people living with Parkinson’s disease (PD) offers the promise of meeting complex care needs in a person-centered way that addresses fragmentation and improves quality of life. The purpose of our research was to co-design a care delivery model that supports both social and medical care from the perspective of patients and care partners. In the first step of our co-design approach, participants from five countries were invited to share their experiences of living with PD during a narrative interview. A qualitative analysis of these narrative interviews based on the Corbin and Strauss model was done to map out patients’ trajectories. Three typical trajectories were identified: (a) the “unpredictable” trajectory, (b) the “situated” trajectory, and (c) the “demanding” trajectory. Based on the analysis of these trajectories, we were able to integrate various patient experiences into the design of an integrated care network.

An advanced self-care delivery model for leg ulcer management: a service evaluation

Background: Lower limb ulceration is a common cause of suffering in patients and its management poses a significant burden on the NHS, with venous leg ulcers (VLUs) being the most common hard-to-heal wound in the UK. It is estimated that over one million patients in the UK have lower limb ulceration, of which 560,000 were categorised as VLUs, with a cost burden of over £3 billion each year. Objective: The aim of this service evaluation was to assess the effects of implementing a self-care delivery model on clinical outcomes with the intention of limiting face-to-face health professional contact to one appointment every 6 weeks. Method: A suitability assessment was conducted and a cohort of patients were moved to a self-care delivery model. Patient data were collected, anonymised and independently analysed, comparing time to healing against data on file from a previous report. Results: This highlighted that, in 84 of the 95 patients selected, the VLUs had healed by week 24 on the pathway, a further 10 patients' VLUs had healed by week 42 and only one remaining patient reached 42 weeks without healing. Conclusion: These results support the hypothesis that patients with VLUs can self-care and deliver clinical effectiveness. It is recommended that all services explore the possibility of introducing a self-care model for VLU care.