Accuracy of remote dermatology care concerns researchers

A study of direct-to-consumer telemedicine services published this week in JAMA Dermatology raises troubling questions about the accuracy of diagnosis and treatment of skin problems.

The researchers, from the University of California, San Francisco and elsewhere, are concerned about the expansion of health plan coverage for these services, especially when coverage is denied for asynchronous telemedicine provided by a patient's existing specialists.

For the study, the researchers created six dermatologic cases, including photos, which they used to pose as patients for 62 clinical encounters. The study involved seven direct-to-consumer general medicine websites and nine dermatology-focused companies and apps offering services to patients in California.

It found major diagnoses repeatedly were missed, including syphilis, herpes and skin cancer, and relevant questions were not asked. Treatments sometimes were at odds with existing guidelines.

What's more, prescription medications were ordered in 65 percent of cases, but adverse effects (32 percent) or pregnancy risks (43 percent) weren't always addressed.

Additionally, 68 percent of patients had no choice of physician. Only 26 percent of sites addressed clinician licensure, and some used internationally based physicians without California licenses, as required by state law. The services asked the name of the patient's primary care physician in only 23 percent of cases, and offered to send records of the encounter only 10 percent of the time.

"Until improvements are made, patients risk using healthcare services that lack transparency, choice, thoroughness, diagnostic and therapeutic quality, and care coordination," the authors wrote.

The study did not compare the care quality with that of in-person visits, which have been found to have problems, too, as a Wall Street Journal article points out.

To learn more:
- check out the research
- read the WSJ article