Direct-to-Patient Teledermatology During COVID-19 Lockdown in a Health District in Madrid, Spain: The EVIDE-19 Pilot Study

Abstract

Background: Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction.

Material and method: Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS.

Results: Of the 1,497 patients who agreed to participate in the study, 25% (n=374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n=318); 87.1% (n=325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n=290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema.

Discussion: Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology.

Keywords: Asynchronous; Asíncrona; COVID-19; Remote; Store and forward; Teledermatology; Teledermatología; Telemedicina; Telemedicine; Virtual.

Graphical abstract

Figura 1

Flowchart del reclutamiento del estudio.

Figura 2

Porcentaje de pacientes en cada categoría diagnóstica.

Figura 3

Imágenes enviadas a través de la App. A) Pitiriasis rosada. B) Escabiosis. C) Lesión pigmentada que precisa estudio dermatoscópico. D) Impétigo.

Figura 4

Capacidad diagnóstica y grado de confianza 1-10 en el diagnóstico emitido según categorías diagnósticas.

Figura 5

Continuidad asistencial. Porcentaje de altas y revisiones a uno, 3 y 6 meses.

Figura 6

Escala Likert de satisfacción según enfermedades: totalmente de acuerdo (TA), de acuerdo (A), neutral (N), en desacuerdo (D), totalmente en desacuerdo (TD).