Is Teledermatology Living Up to Its Promise? A Look at Patient Satisfaction

🔍 Key Finding

Patients report high satisfaction with both store-and-forward and live-video teledermatology, valuing increased access and quality of care, but technical difficulties, privacy concerns, and limitations in physical exams can negatively impact satisfaction, particularly among older, less tech-savvy, and socioeconomically disadvantaged patients. Addressing these barriers through improved technology, patient education, and policy changes is crucial for equitable and effective teledermatology implementation.

🔬 Methodology Overview

Design: Updated narrative review of recent findings on patient satisfaction in teledermatology. Data Sources: Published literature focusing on patient satisfaction in both store-and-forward and live-interactive teledermatology modalities. Includes a systematic review from 2010-2020 and studies from 2020-2022. Selection Criteria: Studies examining patient satisfaction with teledermatology, encompassing various aspects of patient experience (accessibility, quality of care, patient-provider relationship, technical quality, overall satisfaction, etc.). Analysis Approach: Qualitative synthesis of findings from selected studies, comparing and contrasting results across different teledermatology modalities and patient demographics. Scope: Focuses on patient satisfaction with teledermatology, exploring factors that influence satisfaction levels and highlighting the digital divide in access and experience. Also briefly touches on provider perspectives.

📊 Results

• Patients generally express high satisfaction with both store-and-forward and live-video teledermatology, valuing accessibility, quality of care, and patient-provider relationships.
• Decreased patient satisfaction is linked to technical difficulties, privacy concerns, lack of procedure availability, and thorough physical exams.

• 70% of patients reported at least equal satisfaction with live-interactive visits compared to in-person visits across domains like visit preparation, provider communication, physical examination, and treatment/follow-up. However, >25% were dissatisfied with the virtual physical exam, and 57.9% preferred in-person examinations.

• Male gender was associated with treatment plan/follow-up satisfaction in live-interactive teledermatology. Patients >66 years old preferred in-person visits across most domains compared to younger patients.
• Studies pre-COVID-19 showed that while most patients were satisfied with store-and-forward teledermatology, 42% still preferred face-to-face visits, and 17% felt something was missing in teledermatology compared to in-person visits.
• Disparities exist in telemedicine access and satisfaction. Non-White patients reported lower satisfaction and confidence, with greater concerns for privacy. Asians were 31% less likely to use telemedicine and Blacks were 35% less likely to have their video on compared to White patients.

💡 Clinical Impact

Teledermatology demonstrates high patient satisfaction, particularly for accessibility and convenience, suggesting its potential for wider integration into routine dermatological care. However, addressing limitations related to technical difficulties, privacy concerns, and the digital divide is crucial to optimize patient experience and ensure equitable access across diverse populations.

🤔 Limitations

• Technical difficulties
• Privacy concerns
• Lack of procedure availability
• Limited physical exams
• Quality of video images (in live video teledermatology)
• Low reimbursements (for providers)
• Concerns regarding malpractice/liability (for providers)
• Government regulations (for providers)

✨ What It Means For You

Dermatologists should be aware that patient satisfaction with teledermatology, while generally high, is influenced by factors like age, technical literacy, and socioeconomic status, and may be lower for those requiring procedures or thorough physical exams. Improving patient education, addressing technical barriers, and offering hybrid approaches can enhance patient experience and address disparities in access and satisfaction. Furthermore, providers should be aware of their own potential biases and concerns regarding image quality and medico-legal issues when utilizing teledermatology.

Reference Santiago S, Lu J. Patient Satisfaction in Teledermatology: an Updated Review. Current Dermatology Reports. 2023;12:23–26. https://doi.org/10.1007/s13671-023-00382-z