Randomized controlled trial comparing store-and-forward teledermatology alone and in combination with web-camera videoconferencing

Abstract

Background: Studies on the reliability of teledermatology have shown considerable variability in results. Only one study has compared asynchronous and synchronous methods.

Objectives: This report describes DERMATEL, a prospective, randomized diagnostic-concordance study that sought to evaluate the relative advantages, in terms of reliability, of two remote consultation techniques.

Methods: Patients referred by 18 general practitioners were randomized (4 : 4 : 2) to three study groups: store and forward (SF), hybrid videoconferencing-SF (VC-SF), and a control group. In total, 457 patients were assigned: 192 to the SF group, 176 to the VC-SF group and 89 to the control group. High-quality still images were used throughout, with additional use of standard web-camera (webcam) videoconferencing in the VC-SF group. All patients were also seen by the same dermatologist in a face-to-face (FTF) consultation, considered the practical reference standard. Two different dermatologists assessed concordances between the teledermatology and FTF consultations.

Results: There were no significant differences in age, gender or diagnostic category between the three groups, and the images (82%), clinical history (91%) and diagnostic confidence (89%) were high-quality. Online management was possible for 70% of cases. Agreement between teledermatology and the FTF consultation was high for both diagnosis (> 0.85) and treatment (> 0.78). Concordance in diagnosis was influenced by image quality (P < 0.001), confidence in diagnosis (P < 0.001) and need for conventional consultation (P < 0.001), rather than by quality of clinical history (P = 0.58) or method of teleconsultation (P = 0.340).

Conclusions: Intraobserver reliability is very high in teledermatology. When history taking and training in digital photography are standardised, a hybrid system with audio is no better than SF alone.