Can E-Consults Bridge the Gap in Dermatological Care at a County Hospital?

🔍 Key Finding A dermatology e-consult service at Grady Memorial Hospital, using a store-and-forward method, reduced in-person dermatology visits by 38% and potentially shortened new patient appointment wait times, suggesting its effectiveness in improving access to dermatologic care for underserved populations. The majority of e-consults were for inflammatory/infectious conditions, and recommendations provided through the service often negated the need for a traditional in-person visit.

🔬 Methodology Overview Design: Retrospective chart review. Setting: Grady Memorial Hospital, a county hospital serving Fulton and DeKalb counties in Georgia. Patients: 544 patients receiving dermatology e-consults between March 2019 and March 2021. Intervention: Implementation of a store-and-forward teledermatology “e-consult” system. Data Collection: Patient demographics, diagnoses, referral source (main hospital clinics vs. satellite clinics), and whether the e-consult recommendation avoided an in-person visit. Analysis: Descriptive statistics summarizing patient characteristics and the impact of the e-consult service on in-person visit rates and wait times.

📊 Results Here are the key findings of the dermatology e-consult pilot study:

Total e-consults: 544 patients received dermatological e-consults between March 2019 and March 2021. Patient origin: 75% of patients originated from the main hospital clinics, 22% from satellite clinics, and 3% from other locations. Etiology of diagnoses: 73% of cases were inflammatory/infectious, 23% were neoplastic (majority benign), and 4% were undetermined/lacked photos. E-consult sufficiency: 38% (204/544) of patients avoided an in-person dermatology visit based on the e-consult recommendations and subsequent PCP management. Impact on wait times: New patient appointment wait times decreased from approximately three months to two months following implementation of the e-consult service, correlating with the reduction in in-person visits.

💡 Clinical Impact This study suggests that store-and-forward teledermatology can effectively reduce the need for in-person dermatology visits for a substantial portion of patients, potentially improving access to care and decreasing wait times for in-person appointments, particularly in underserved populations. This model of care could be adopted by other healthcare systems to improve efficiency and address disparities in dermatology access.

🤔 Limitations Limited number of studies assessing teledermatology’s impact on health disparities. Causal relationship between e-consults and reduced wait times cannot be definitively established from the data. Study focuses on a specific patient population (Grady Health System) and may not be generalizable to other settings. Reliance on store-and-forward method may not be suitable for all dermatological conditions requiring real-time assessment. Further research is needed to fully evaluate the long-term effectiveness and impact of the e-consult service.

✨ What It Means For You This study suggests that implementing teledermatology e-consults can reduce the burden of in-person dermatology visits, freeing up appointment slots and potentially decreasing wait times for patients requiring specialist care. This model may be particularly beneficial in underserved communities and county hospital settings where access to dermatologists is often limited.

Reference Joseph SM, Aspey L, Chisolm S. Dermatology e-consult at a county hospital: pilot review. Dermatology Online Journal. 2023;29(1):17. https://doi.org/10.5070/D329160223