Our study demonstrates overall positive attitudes towards teledermatology. However, decreased satisfaction and confidence were found amongst older and non-White patients. Patients with longer vs shorter clinic proximity preferred telemedicine to in-person visits, which may improve access to care in areas without dermatologists.
Our study showed privacy concerns among non-White participants. Similarly, in a study using a semi-structured interview script to survey African-Americans (n=43) on perceived advantages/ disadvantages of telemedicine, participants were concerned with confidentiality.1 In a cohort study of 148,402 patients scheduled for primary care and subspecialty telemedicine visits, Asians were 31% less likely to use telemedicine and Blacks were 35% less likely to have their videos on compared to Whites.2 While telemedicine has facilitated access to dermatological care during the pandemic, it is important to manage confidentiality concerns to encourage equitable telemedicine use.
There was less telemedicine acceptance for older vs younger patients in our study. Similarly, in the previously referenced cohort study, patients <55 vs ≥55 were more likely to use telemedicine (<55:43%, 55–64:22%, 65–74:21%, ≥75:15%; P<.001).1 The 2018 National Health and Aging Trends Study estimated that 13 million (38%) older adults in the United States would have technological difficulties with telemedicine.4 Simplified connections, education on photography, and practice runs preceding televisits may overcome challenges for older patients.5
This study is subject to limitations. Results may not be generalizable as participants were English-speaking adults in a single academic medical center in New York. The majority were White and non-Hispanic with a college education or higher. Additionally, teledermatology utilization during the COVID-19 pandemic may not be representative of teledermatology in more balanced times.
