Can Teledermatology Bridge the Gap in Dermatology Care for the Underserved?

🔍 Key Finding This study found that lack of insurance, residing in a medically underserved area, and low income were the most significant barriers to dermatological care among the underserved population. Despite some logistical challenges and provider preferences for in-person care, teledermatology was identified as a potential solution to improve access.

🔬 Methodology Overview

• Design: Quantitative descriptive study using an online survey.
• Participants: Practicing dermatologists who were members of Georgia, Missouri, Oklahoma, or Wisconsin dermatology associations.
• Survey Instrument: Adapted questions from the 1998 Ohio Family Health Survey (OFHS) for barriers to care and the McFarland Teledermatology Provider and Imaging Technician Satisfaction Survey for teledermatology access. Demographic data also collected.
• Data Collection: Online survey via SurveyMonkey link distributed by dermatology associations (February 2019 - April 2019).
• Data Analysis: Descriptive statistics using IBM SPSS Statistics Version 25 (frequencies, percentages, median, IQR). Rank-ordering of barriers and 5-point Likert scale analysis for teledermatology items.
• Sample Size: 38 respondents for demographics, 22 for survey items (from a potential pool of 700).

📊 Results

• Top Barriers to Dermatologist Care: The most concerning barriers to dermatological care for underserved populations were “continually uninsured” (n = 8; 36.40%), “resides in a medically underserved county” (n = 5; 22.70%), and “family under federal poverty level” (n = 7; 33.30%).
• Teledermatology Support: A majority of dermatologists (n = 20; 90.90%) viewed teledermatology as a potential addition to regular patient care, and most (n = 18; 81.80%) believed it could increase patient access. A smaller majority (n = 6; 72.70%) considered it a convenient form of healthcare delivery.
• Teledermatology Concerns: While generally supportive of teledermatology, some dermatologists expressed concerns about the lack of physical contact for examinations and a preference for in-person visits. There were also concerns about the reliability of the technology.
• Demographics: The median age of responding dermatologists was 54 (IQR = 17) years. Most were male (n = 13; 54.20%), held MD degrees (n = 25; 65.80%), had a median income of $200,000 or more (IQR = 0), worked in private practice (n = 24; 96.00%), were located in suburban areas (n = 15; 60.00%), and did not have teledermatology training (n = 14; 56.00%).
• Limited Sample Size: The study had a small sample size (n = 22 for survey items, out of 38 total respondents to demographics), limiting the generalizability of the findings. The overall response rate was 5.43%, with a complete survey response rate of 3.14%.

💡 Clinical Impact This study identifies insurance status, medically underserved county residence, and income level as key barriers to dermatologic care for melanoma and non-melanoma skin cancer in the underserved, suggesting the need for interventions to improve access. Furthermore, it suggests that teledermatology may offer a viable solution to improve access, though further research is needed to address logistical and cost barriers.

🤔 Limitations

• Small sample size reducing the generalizability of the study results.
• Sampling method did not reach a large enough number of practicing dermatologists.
• Limited time allotted for the study, addressing two different research questions instead of one.

✨ What It Means For You Dermatologists should consider incorporating teledermatology into their practice to expand access to underserved populations, particularly those who are uninsured, low-income, or live in medically underserved areas. Further research is needed to address logistical and financial challenges of implementing teledermatology, including equipment costs, patient transportation for in-person follow-up, and treatment costs. This will help ensure equitable access to dermatological care and improve outcomes for melanoma and non-melanoma skin cancers.

Reference Duniphin DD. Limited Access to Dermatology Specialty Care: Barriers and Teledermatology. Dermatol Pract Concept. 2023;13(1):e2023031. https://doi.org/10.5826/dpc.1301a31