By offering virtual dermatology and Medicaid coverage, the number of patients who saw a dermatologist nearly doubled, according to a new RAND Corp. study, illustrating how virtual care can increase patient access to specialists.
A Veterans Affairs clinic in Spokane, Washington, has also reported a similar increase in cases with the introduction of teledermatology.
For the study, published in JAMA Dermatology, researchers examined more than 380,000 members of Health Plan of San Joaquin, a MediCal- managed plan in California's Central Valley, including about 108,000 who were newly enrolled under provisions of the Affordable Care Act. The region has only about one-third the national average number of dermatologists, according to an announcement.
Originally, some primary care physicians who referred patients to teledermatology provided background about patients and took digital images of skin problems, which were uploaded to a secure website. They then received a consult report within a few days.
Over time, however, patients were referred to two brick-and-mortar clinics to have photographs taken and to be interviewed by a teledermatology nurse. The remote dermatologist then reviewed the history and images, with the diagnosis and treatment relayed to both the patient and referring primary care provider. If necessary, an in-person follow-up visit was scheduled with the dermatologist.
The authors found about half the plan's members who saw a dermatologist did so virtually; however 75 percent of the new Medicaid enrollees were treated via telemedicine.
The teledermatology patients were more likely to be male, under 17, nonwhite and without comorbid conditions. They were most often seen for issues such as warts or acne. In-person visits tended to be for more complex cases such as psoriasis and skin cancers.