Did COVID-19 Change Inpatient Dermatology Consultations for the Better? A Look at Teledermatology Perceptions and Practices.

🔍 Key Finding Inpatient teledermatology use among surveyed dermatology hospitalists increased significantly during the COVID-19 pandemic, with most providers reporting a more positive opinion of teledermatology and citing benefits such as increased efficiency and access; however, some concerns regarding communication barriers and potential negative perceptions of dermatology within medicine were also noted.

🔬 Methodology Overview

• Design: Cross-sectional survey study.
• Participants: Members of the Society for Dermatology Hospitalists (SDH).
• Survey Distribution: Electronic survey distributed via the SDH listserv on September 16, 2020.
• Survey Content: 31 questions assessing attitudes, barriers, and protocols related to inpatient teledermatology before and after the COVID-19 pandemic, including an open-response section.
• Data Analysis: Descriptive analysis performed using Excel.
• Sample Size: 22 respondents representing 20 institutions (one response eliminated from institutions with two responses to avoid duplication).

📊 Results

• Increased telehealth use: Inpatient teledermatology consult use increased from 40% (8/20 providers) pre-pandemic to 90% (18/20) during the COVID-19 pandemic.
• Shift in opinions: 80% (16/20) of providers’ opinions on teledermatology changed due to the pandemic, with 87.5% (14/16) reporting a more positive view.
• Predominance of store-and-forward: 83.3% (15/18) of providers using teledermatology utilized store-and-forward technology without live interaction. Only 11.8% (2/17) required full-body images for store-and-forward consults.
• Need for in-person follow-up: In-person consults were needed less than 25% of the time following a teledermatology evaluation in 75% of cases.
• Perceived barriers: Concerns about inadequate photos, communication difficulties with patients and consulting teams, and the potential negative impact on the perception of dermatology within medicine were raised.
• Formal protocols: While only one respondent reported a formal protocol for inpatient teledermatology pre-pandemic, 77.8% (14/18) developed one during the pandemic.

💡 Clinical Impact Inpatient teledermatology use significantly increased during the COVID-19 pandemic, offering benefits like efficiency and increased access, but also posing challenges in patient communication and potential for marginalization of dermatology within the broader medical field. Robust algorithms and utilization criteria may help optimize teledermatology use while mitigating risks.

🤔 Limitations

• Limited sample size.
• Only attending Dermatology Hospitalists were surveyed.
• Mostly academic medical centers were surveyed.
• Potential for missing important diagnoses that may be captured by bedside total body exam.
• Potential for negative perceptions of dermatology by asking the team to take time to obtain photos or re-take photos.
• Potential for inadequate or inaccurate photos leading to misdiagnosis.
• Potential communication barriers with patients and medical teams.

✨ What It Means For You This study highlights the increased use of inpatient teledermatology during the COVID-19 pandemic and its potential to improve efficiency and access to dermatologic care. However, clinicians should be mindful of potential communication barriers with patients and consulting teams, and the need for robust protocols to ensure accurate diagnoses and appropriate utilization. Clear communication with patients and medical teams, along with close outpatient follow-up, can help mitigate some of these challenges.

Reference Zheng L, Guggina LM, Zhou XA, Wanat KA, Brieva JC, Trinidad JC, Nguyen CV. Perceptions of telehealth among inpatient consultative dermatology providers and practice patterns during COVID-19. Archives of Dermatological Research. 2023;315:2449-2451. https://doi.org/10.1007/s00403-023-02637-y