Telemedicine eczema care just as effective as office visits

(Reuters Health) - After a year of emailing photos of their skin and communicating with their dermatologists online, eczema patients showed just as much improvement as people who saw their own doctors in person, according to a new study.

“Patients often report having to drive long distances and take time away from work and school to care for their skin,” said Dr. April Armstrong, the study’s lead author.

Atopic dermatitis, also known as eczema, “affects many children, and many parents have to take children out of school and take time out of work themselves to get physician recommendations - there is a true demand from patients for new ways of receiving care,” said Armstrong, a dermatologist at the University of Colorado in Denver.

There are not enough dermatologists in the United States to meet the demand for services, Armstrong and her colleagues write in JAMA Dermatology. Teledermatology, or the remote delivery of dermatology services using telecommunications technology, could help ease that demand, they say.

To compare the effectiveness of online treatment to traditional in-office visits for a chronic condition like eczema, the researchers recruited 156 adults and children with eczema who lived near Sacramento, California, and had access to the Internet, computers and digital cameras.

All the patients saw their dermatologists in person for an initial visit. Then half of them got follow-up care in further office visits, while the other half sent pictures of their eczema to the dermatologist, who recommended treatments and prescribed medications electronically.

In both groups, the eczema severity was measured using a standard patient questionnaire. Higher scores indicated greater severity, with a maximum score of 28. After one year, scores among patients in the online group had dropped by an average of 5.1 points. In the in-person group, they fell by an average of 4.9 points.

In addition, the study team assessed the images and gave them scores ranging from 0 for “clear” up to 5 for “very severe.” By the study team’s scoring system, 38.4 percent of the online group achieved scores of 0 or 1, compared to 43.6 percent in the in-person group.

In both scoring systems, the differences between the online and in-person groups after one year were so small, statistically, they are considered nonexistent.

“This is the first study in atopic dermatitis that has shown that patients who receive follow up care online improved to the same extent as those who saw their dermatologists in person,” Armstrong said. “This online care is very innovative because it allows patients to receive care in the comfort of their own home.”

For patients interested in this type of care, she said, it’s important that they “seek online care from qualified practitioners and make sure that those online practitioners are board certified dermatologists.”

It’s also important for patients to inform their primary care physicians that they are getting online care and that the dermatologists communicate their findings and recommendations to the primary doctors, Armstrong added.

Dr. Jack Resneck said the specialty of dermatology has a great deal of experience with the use of telemedicine, including many rigorous studies showing when it can be used effectively, and when it can’t.

“This study was new and interesting because it measured the clinical outcomes of patients with eczema who were given online direct access to their board-certified dermatologist by telemedicine (after having seen the dermatologist in person) for follow-up care for a full year,” Resneck, from the University of California, San Francisco School of Medicine, told Reuters Health in an email.

Resneck, who wasn’t involved in the new study, said this type of well-designed telemedicine does have the potential to improve access and reduce disparities for patients with skin disease in underserved areas with a shortage of dermatologists, but there are two caveats.

“First, it’s important to note that this study provided highly coordinated telemedicine care with a physician who had an existing relationship with the patient – it is critical that as we expand telemedicine, it’s done in a way that provides this type of transparent, coordinated care rather than creating fragmented care completely outside of the patient’s existing healthcare team,” he said.

Examples of fragmented types of telemedicine include electronic prescriptions from clinicians with whom patients have no relationship, with minimal follow-up, no local backup plan for urgent issues, and no information sharing with the existing, local healthcare team, he said.

“Second, for the type of highly coordinated and effective telemedicine demonstrated in this new study to expand and be successful, both private and government insurers will have to remove existing barriers so that high quality, coordinated telemedicine encounters can be paid for,” Resneck said.

SOURCE: JAMA Dermatology, online October 22, 2014.