Store-and-Forward Teledermatology Using Mobile Phones: Clinical Efficacy in a Rural Primary Healthcare Centre Free Clinic Setting

  • Vanessa M. Carpio Section of Dermatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Belen Dofitas University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Clarita Maano University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Carmela Dayrit University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Joahnna Villena University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Monica Jara University of the Philippines-Philippine General Hospital, Manila, Philippines
  • Alvin Marcelo University of the Philippines, Manila
  • Anthony Cordero University of the Philippines-Philippine General Hospital, Manila, Philippines
Keywords: telemedicine, mhealth, mdermatology, rural health, treatment outcome, efficacy, concordance.

Abstract

Background: Technological advances increase the feasibility of mobile-phone teledermatology (mdermatology). By saving time and costs, underserved areas lacking dermatologists may benefit greatly. Objectives: To assess the clinical efficacy of mobile-phone store-and-forward mdermatology compared to face-to-face consultation. Methods: Patients from a rural health centre in Batangas were randomised to either mdermatology or face-to-face group. In the mdermatology group, a general practitioner (GP) assessed patients, took photographs using a cell phone camera and sent these via e-mail accessed via the GP’s mobile phone to the mdermatologist’s mobile phone. In the face-to-face group, the GP assessed patients and then referred them to the face-to-face dermatologist. Both the mdermatologist   and face-to-face dermatologist provided assessments and plans for patients in their respective groups. Clinical outcomes were assessed after two and four weeks. Results: A total of 123 patients were included, with 60 participants in the mdermatology group and 63 in the face-to-face group.  In both groups, most participants improved. There were no significant differences in clinical outcomes assessed by GPs (p=0.074), dermatologists (p=0.172), or participants (p=0.405). The diagnostic strength of agreement between the GP and the dermatologist differed between the two groups (Cohen’s κ=0.5775 vs. 0.2735), but management concordance was similar (p=0.775). Conclusion: Store-and-forward teledermatology using mobile phones in the dermatologic management of patients in a rural primary healthcare centre free clinic setting is feasible. This study did not find mobile teledermatology inferior to face-to-face consultation.

Author Biographies

Vanessa M. Carpio, Section of Dermatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines

Medical Officer

Section of Dermatology, Department of Medicine

Belen Dofitas, University of the Philippines-Philippine General Hospital, Manila, Philippines

Consultant

Section of Dermatology, Department of Medicine

Clarita Maano, University of the Philippines-Philippine General Hospital, Manila, Philippines

Consultant

Section of Dermatology, Department of Medicine

Carmela Dayrit, University of the Philippines-Philippine General Hospital, Manila, Philippines
Section of Dermatology, Department of Medicine
Joahnna Villena, University of the Philippines-Philippine General Hospital, Manila, Philippines

Section of Dermatology, Department of Medicine

Monica Jara, University of the Philippines-Philippine General Hospital, Manila, Philippines
Section of Dermatology, Department of Medicine
Alvin Marcelo, University of the Philippines, Manila

Director

National Telehealth Centre

Anthony Cordero, University of the Philippines-Philippine General Hospital, Manila, Philippines

Faculty

Department of Family and Community Medicine

References

Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The empirical foundations of teledermatology: a review of the research evidence. Telemed J E Health 2015;21(12):953-979. doi: 10.1089/tmj.2015.0146. PubMed PMID: 26394022; PubMed Central PMCID: PMC4776540.

Abad-Casintahan F, Chow SK, Goh CL, et al. Toward evidence-based practice in acne: consensus of an Asian Working Group. J Dermatol 2011;38(11):1041-1048. doi: 10.1111/j.1346-8138.2011.01266.x. PubMed PMID: 21950538.

Whited JD, Warshaw EM, Kapur K, et al. Clinical course outcomes for store and forward teledermatology versus conventional consultation: a randomized trial. J Telemed Telecare 201319(4):197-204. doi: 10.1177/1357633X13487116. PubMed PMID: 23666440.

Deshpande A, Khoja S, Lorca J et al. Asynchronous telehealth: a scoping review of analytic studies. Open Med 2009;3(2):e69-91. PubMed PMID: 19946396; PubMed Central PMCID: PMC2765770.

Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part II: Emerging technologies in teledermatology, limitations and future directions. J Am Acad Dermatol 2015;72(4):577-586; quiz 587-8. doi: 10.1016/j.jaad.2014.08.014. PubMed PMID: 25773408.

Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33(2):363-374. PubMed PMID: 884196.

Lansang PT. Teledermatology and clinic-based consultation: agreement and acceptability in the Philippine setting. J Philipp Dermatol Soc 2001;11(1).

Mendoza-Ramirez AC, Ramirez M, Jara MF, et al. The usefulness of mobile phone images in the diagnosis of common dermatologic diseases: A pilot study. UP-PGH Phil. Forthcoming 2016.

Coates SJ, Kvedar J, Granstein RD. Teledermatology: from historical perspective to emerging techniques of the modern era: part I: History, rationale, and current practice. 2015;72(4):563-574. doi: 10.1016/j.jaad.2014.07.061. Review. PubMed PMID: 25773407.

Pak H, Triplett C, Lindquist J, Grambow S, Whited J. Store-and-forward teledermatology results in similar clinical outcomes to conventional clinic based care. J Telemed Telecare 2007;13:26–30.

Watson AJ, Bergman H, Williams CM, et al. A randomized trial to evaluate the efficacy of online follow-up visits in the management of acne. Arch Dermatol 2010;146(4):406-411. doi: 10.1001/archdermatol.2010.29. PubMed PMID: 20404229.

Eminović N, de Keizer NF, Wyatt JC, et al. Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial. Arch Dermatol 2009;145(5):558-564. doi: 10.1001/archdermatol.2009.44. PubMed PMID: 19451500.

Ferrándiz L, Ruiz-de-Casas A, Martin-Gutierrez FJ, et al. Effect of teledermatology on the prognosis of patients with cutaneous melanoma. Arch Dermatol 2012;148(9):1025-1028. doi: 10.1001/archdermatol.2012.778. PubMed PMID: 22986852

Philippines - Telecoms, Mobile and Broadband Publication Overview. (2015). Available at: https://www.budde.com.au/Research/2015-Philippines-Telecoms-Mobile-and-Broadband accessed 6 December 2016.

Philippines - Telecoms, Mobile, Broadband and Digital Media - Statistics and Analyses. (2016). Available at: https://www.budde.com.au/Research/Philippines-Telecoms-Mobile-Broadband-and-Digital-Media-Statistics-and-Analyses accessed 6 December 2016.

Chung P, Yu T, Scheinfeld N. Using cellphones for teledermatology, a preliminary study. Dermatol Online J 2007;13(3):2. PubMed PMID: 18328196.

Ebner C, Wurm EM, Binder B, et al. Mobile teledermatology: a feasibility study of 58 subjects using mobile phones. J Telemed Telecare 2008;14(1):2-7. doi: 10.1258/jtt.2007.070302. PubMed PMID: 18318921.

Tran K, Ayad M, Weinberg J, et al. Mobile teledermatology in the developing world: implications of a feasibility study on 30 Egyptian patients with common skin diseases. J Am Acad Dermatol 2011;64(2):302-309. doi: 10.1016/j.jaad.2010.01.010. PubMed PMID: 21094560.

Lamel SA, Haldeman KM, Ely H, et al. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol 2012;67(4):576-581. doi: 10.1016/j.jaad.2011.11.957. PubMed PMID: 22243769.

Feldman SR, Fleischer AB, Chen JG. The gatekeeper model is inefficient for the delivery of dermatologic services. J Am Acad Dermatol 1999;40(3):426-432.

Published
2017-01-28
How to Cite
Carpio, V., Dofitas, B., Maano, C., Dayrit, C., Villena, J., Jara, M., Marcelo, A., & Cordero, A. (2017). Store-and-Forward Teledermatology Using Mobile Phones: Clinical Efficacy in a Rural Primary Healthcare Centre Free Clinic Setting. Journal of the International Society for Telemedicine and EHealth, 4, e28 (1-7). Retrieved from https://journals.ukzn.ac.za/index.php/JISfTeH/article/view/161
Section
Special Theme: Telehealth in the Philippines