Maintenance Notice

Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Wednesday, July 01, 2020 at 8:00 PM to 10:00 PM EST. We apologize in advance for any inconvenience this may cause you.

Who will be affected?

Accepted for/Published in: JMIR Dermatology

Date Submitted: Apr 12, 2022
Date Accepted: Sep 13, 2022
Date Submitted to PubMed: Aug 26, 2023

The final, peer-reviewed published version of this preprint can be found here:

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

Lamb JE, Fitzsimmons R, Sevagamoorthy A, Kovarik CL, Shin DB, Takeshita J

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

JMIR Dermatol 2022;5(4):e38694

DOI: 10.2196/38694

PMID: 37632882

PMCID: 11340776

Patient factors associated with teledermatology visit type and submission of photographs during the COVID-19 pandemic: A cross-sectional analysis

  • Jordan E Lamb; 
  • Robert Fitzsimmons; 
  • Anjana Sevagamoorthy; 
  • Carrie L Kovarik; 
  • Daniel B Shin; 
  • Junko Takeshita

ABSTRACT

Background:

The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient’s skin, with photographs being preferred over live video for virtual skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs.

Objective:

The aim of this study was to identify patient characteristics associated with type of telemedicine visit, as well as factors associated with participating in teledermatology visits with digital photographs versus without photographs.

Methods:

We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least one teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were: (i) participation in a live-interactive video visit versus a telephone visit, and (ii) participation in any teledermatology visit with photographs versus without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes.

Results:

In total, 6,254 unique patients completed at least one teledermatology visit during the study period; 69.0% (n=4,315) of patients participated in a video visit and 31.0% (n=1,939) participated in a telephone visit. A minority of patients (31.3%, n=1,955) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, education, and greater access to a computer and high-speed internet (p<.001 for all). In adjusted analysis, older age (age group >75, OR 0.58; 95% CI 0.43-0.78), male sex (OR 0.82; 95% CI 0.73-0.92), Black race (OR 0.78; 95% CI 0.64-0.94), and Medicaid insurance (OR 0.82; 95% CI 0.68-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75, OR 0.33, 95% CI 0.25-0.45) and Black race (OR 0.81, 95% CI 0.67-0.96) were also associated with lower odds of a patient participating in a video visit versus telephone visit.

Conclusions:

Patients who were older, male, Black, or had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for virtual dermatology visits and develop targeted interventions to facilitate equitable participation in teledermatology care.


 Citation

Please cite as:

Lamb JE, Fitzsimmons R, Sevagamoorthy A, Kovarik CL, Shin DB, Takeshita J

Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis

JMIR Dermatol 2022;5(4):e38694

DOI: 10.2196/38694

PMID: 37632882

PMCID: 11340776

Download PDF


Request queued. Please wait while the file is being generated. It may take some time.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.