Teledermatology Platforms Usage and Barriers: A Cross-Sectional Analysis of United States-Based Dermatologists Pre- and Post-COVID-19
February 2024 | Volume 23 | Issue 2 | e64 | Copyright © February 2024
Published online January 24, 2024
Justin W. Marson MDa, Rebecca M. Chen MDa, Maham Ahmad BAb, Graham H. Litchman DO MSc, Sara Perkins MDb, Darrell S. Rigel MD MSd
aDepartment of Dermatology, SUNY Downstate Health Sciences University, Brooklyn, NY
bDepartment of Dermatology, Yale University School of Medicine, New Haven, CT
cDepartment of Dermatology, St. John’s Episcopal Hospital, Far Rockaway, NY
dDepartment of Dermatology, Mt. Sinai Icahn School of Medicine, New York, NY
Abstract
Background: During the global COVID-19 pandemic, dermatologists increasingly adopted teledermatology to facilitate patient care.
Objective: To identify differences in teledermatology platform usage and functionality among dermatologists as a means of understanding the potential effect on virtual healthcare access.
Methods: Results from a 2021 cross-sectional pre-validated survey distributed to actively practicing United States dermatologists were analyzed based on timepoint when teledermatology was adopted relative to COVID-19, previous/currently used platforms, self-reported platform functionality, and barriers to teledermatology implementation. Analysis was performed using chi-square and odds ratios (OR) with 95% confidence intervals (95% CI) for categorical data and single-factor analysis of variance (ANOVA) with post-hoc Tukey-Kramer for continuous data. P<.05 was considered significant.
Results: Early adopters (EAs) trialed significantly more (2.3 vs 1.9, P=0.02) platforms than (post) COVID adopters (CAs) before choosing their current platform. More EAs reported using platforms capable of uploading images (P=.002), required a mobile application (P=.006), and allowed staff to join patient encounters (P<.001). While poor image quality was the most cited barrier to implementation, CAs and non-adaptors (NAs) were materially more likely to cite it as their largest barrier to teledermatology.
Limitations: The retrospective nature of the study and potential response bias.
Conclusion: Dermatologists' use of teledermatology materially correlates with their teledermatology-adoption timepoint, and future usage may be materially impacted by the end of the COVID-19 public health emergency. Future studies should aim at how implementation and barriers to teledermatology usage may impact access to care.
J Drugs Dermatol. 2024;23(2): doi:10.36849/JDD.7819e
INTRODUCTION
United States-based dermatologists adapted to the COVID-19 public health emergency in part by integrating teledermatology into their practices.1,2 Pre-COVID-19, asynchronous or store-and-forward (SAF) teledermatology was a relatively cost-effective tool providing care to patients with minimal healthcare access.3-5 Post- COVID-19, studies suggest that teledermatology usage materially shifted towards synchronous or live-interactive (LI)/video-based modalities.6-13 This study aimed to identify differences between teledermatology-adoption timepoints (TAT) (relative to COVID-19) and associated teledermatology barriers to usage and platform characteristics.
METHODS
This study was exempt per Institutional Review Board (IRB) guidelines. A pre-validated anonymous survey was distributed via email to a proprietary purchased listserv of actively practicing US dermatologists. Completed results were stratified by TAT. Analysis was performed using chi-square, odds ratios (OR) with 95% confidence intervals (95% CI) for categorical data, t-tests for continuous data, and rank-based overlap (RBO) to compare ranked-ordered lists on a continuous scale from 0 (completely different) to 1 (identical) using Python 3.9.6.
RESULTS
Data from 338 practicing dermatologists were analyzed. The analysis regarding demographics and TAT is described in separate studies12,13; briefly, pre-COVID/early adopters (EA) were significantly more likely to have less than or equal to 10 years of experience (YoE) and be associated with academic medical-dermatology practices, while (post-) COVID adopters (CAs) were more likely to have greater than or equal to 20 YoE and be associated with private medical-
