Many Dermatologists To Continue Telehealth Visits After Pandemic

While most U.S. dermatologists did not use telemedicine before the COVID-19 pandemic, a new study suggests many who did deploy virtual visits over the past year will continue the practice going forward.

Researchers examined data from surveys completed by 591 dermatologists (13.6% response rate) to assess utilization of telemedicine before and during the pandemic, intentions about deploying virtual visits after the pandemic, and attitudes about using this technology.

Overall, the proportion of dermatologists using telemedicine surged from 14.1% before the pandemic to 96.9% during the pandemic. Among those who did use the technology, 58.0% said they expected to continue doing so once the pandemic ended.

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"Dermatologists, like most physicians, had little personal experience using telemedicine prior to the pandemic," said senior study author Dr. Jules Lipoff, an assistant professor in dermatology at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

The pandemic essentially cleared several barriers to adopting telemedicine, Dr. Lipoff said by email. Not only did the pandemic give dermatologists a nudge to try a new way of doing things, but it also hastened policy changes that removed concerns about reimbursement, malpractice, and licensing restrictions that were barriers to telemedicine, Dr. Lipoff said.

"Nothing takes the places of personal experience and familiarity in encouraging adoption of a new technology or paradigm of care," Dr. Lipoff added. "I think most dermatologists plan to keep using telemedicine after the pandemic because telemedicine is an amazing tool and method of care that expands access to our patients."

The most common modality for telehealth visits was live interactive exams (94.1%), and the majority of respondents (72.0%) reported that this modality worked best in a hybrid format that combined live video and examination of stored photos.

When researchers asked participants about barriers to telehealth, many of them cited challenges with technology and connectivity during these visits (39.1%), as well as low reimbursement (69.8%), and concerns about medical malpractice (27%) or government regulations (23.2%).

In particular, most dermatologists (85.2%) reported that reimbursement for store-and-forward telemedicine was too low.

Not all types of common dermatology visits were suited to telemedicine, the survey also found. For example, the vast majority of dermatologist felt an in-person visit was required for a total body skin examination (95.7%) but few felt this was necessary to assess acne (2.6%).

The low response rate was a limitation of the study, the authors note in JAMA Dermatology.

Potential benefits of telemedicine in dermatology include expanding access to more patients, particularly when transportation or travel times might be a barrier to care, as well as reducing the infection risk associated with in-person visits, said Dr. Vinayak Nahar, an assistant professor and director of clinical research in the department of dermatology at the University of Mississippi Medical Center in Jackson.

The potential harms include misdiagnosis, or privacy issues with technology, Dr. Nahar, who wasn't involved in the study, said by email. However, telemedicine will likely remain a part of dermatology going forward, Dr. Nahar said.

"Teledermatology offers a number of distinct advantages for timely evaluation of particular dermatologic conditions, helping to provide more efficient care and enhance access to greater numbers of individuals," said Dr. Vinod Nambudiri, of the department of dermatology at Brigham and Women's Hospital and Harvard Medical School in Boston.

"It has become an important mechanism of care delivery and will likely continue to expand its footprint as a key component of digital health," Dr. Nambudiri, who wasn't involved in the study, said by email.

—Lisa Rapaport

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