Teledermatology as a Tool to Improve Access to Care For Medically Underserved Populations: A Retrospective Descriptive Study

With more than 16 million newly insured individuals since the implementation of the Affordable Care Act, dermatologists are challenged to improve access to care. Teledermatology is rapidly emerging as one solution and has been shown to provide high diagnostic accuracy and reproducibility.123 Although traditionally there has been limited literature on teledermatology in safety-net health systems, a recent prospective study of 196 teleconsults4 in an underserved outpatient setting found that the system improved care through dermatologist-recommended management modifications. Our group builds upon this knowledge by investigating whether the Los Angeles County Department of Health Services (LAC-DHS)—a large safety-net health system—was able to use teledermatology to “tele-triage” and manage a proportion of consults solely via telemedicine.This was a retrospective descriptive study involving manual review of teleconsults in the LAC-DHS system placed by primary care providers (PCPs) to 1 of 8 DHS-affiliated dermatologists between July 2012 and May 2014. After 99 exclusions for duplicate or canceled consults, 9499 consults were included (Table I). PCPs suspected any type of cutaneous malignancy in 22% of consults and specifically melanoma in 7%, while dermatologists suspected any malignancy in 9% and melanoma in 2% of consults.

The full study is available here.