Feasibility of store-and-forward teledermatology in out-patient care: A prospective study from rural India utilising specialist referral services through an instant messaging platform - "WhatsApp"
Objectives: The COVID-19 pandemic has placed unprecedented demands on the delivery of health care in rural areas of India. We examined the feasibility of store-and-forward mobile teledermatology for outpatient access to specialist dermatologic care in underserved areas in India. Methods: We conducted a prospective study using smartphone-based teledermatology, connecting six underserved clinics manned by primary care physicians (PCP) to three dermatologists, using the instant messaging platform WhatsApp. We assessed the concordance between PCPs and dermatologists (using Cohen’s kappa coefficient), consultation time, the spectrum of conditions, and the outcome. Results: Of the 730 dermatology patients screened in the clinics, (13%) (36 males and 59 females) required teleconsultation, among which 61.1% were non-infective, 34.7% were infective, and the diagnosis could not be ascertained in 4.2 %. The mean time takenwas 13.5 (± 18.4) minutes. Twenty per cent (n=19) required referral, and 80% (n=76) of consultations could be resolved at the clinic, of whom 36.8 % were cured, 38.2% had moderate, 4% had minimal improvement, 13% were lost to follow-up, and 8% refused treatment. Cure was observed in viral infections and eczema. The diagnostic concordance ranged from low values [0.38 (95% CI: 0-0.68)] in infective to moderate [0.66 (95% CI: 0.42-0.83), p=0.033] in non-infective disorders. Conclusion: Asynchronous mobile teledermatology, using specialist referral via instant messaging platforms, is a powerful modality for providing real-time dermatologic care, while offering a very promising alternative for decreasing healthcare disparities and continuity of services even in adverse situations like the Covid-19 pandemic.
Burdick AE, Simmons SC. The teledermatology train is coming: get on board, get out of the way, or get run over. Cutis 2011;88(5):213-214. PMID: 22272479.
Clark AK, Bosanac S, Ho B, Sivamani RK. Systematic review of mobile phone-based teledermatology. Arch Dermatol Res 2018;10(9):675-689. DOI: https://doi.org/10.1007/s00403-018-1862-4
Zuo KJ, Guo D, Rao J. Mobile teledermatology: a promising future in clinical practice. J Cutan Med Surg 2013;17(6):387-391. DOI: https://doi.org/10.2310/7750.2013.13030
Kaliyadan F. Teledermatology update: Mobile teledermatology. World J Dermatol 2013;2(2):11-15. DOI: https://doi.org/10.5314/wjd.v2.i2.11
Singhal RR, Talati KN, Gandhi BP, et al. Prevalence and pattern of skin diseases in tribal villages of Gujarat: A tele dermatology approach. Indian J Community Med 2020;45(2):199-203. DOI: https://doi.org/10.4103/ijcm.IJCM_76_19
Giordano V, Koch H, Godoy-Santos A, et al. WhatsApp messenger as an adjunctive tool for telemedicine: An overview. Interact J Med Res 2017;6(2):e11. DOI: https://doi.org/10.2196/ijmr.6214.
Pearlman RL, Le PB, Brodell RT, Nahar VK. Evaluation of patient attitudes towards the technical experience of synchronous teledermatology in the era of COVID-19. Arch Dermatol Res 2021;313(9):769-772. DOI: https://doi.org/10.1007/s00403-020-02170-2
Wani SA, Rabah SM, Alfadil S, Dewanjee N, Najmi Y. Efficacy of communication amongst staff members at plastic and reconstructive surgery section using smartphone and mobile WhatsApp. Indian J Plast Surg 2013;46(3):502-505. DOI: https://doi.org/10.4103/0970-0358.121990
Trettel A, Eissing L, Augustin M. Telemedicine in dermatology: findings and experiences worldwide - A systematic literature review. J Eur Acad Dermatol Venereol 2018;32(2):215-224. DOI: https://doi.org/10.1111/jdv.14341
Ashique,KT, Kaliyadan F. Teledermatology in the wake of COVID -19 scenario: An Indian perspective. Indian Dermtol Online J 2020;11(3):301-306. DOI: https://doi.org/ 10.4103/idoj.IDOJ_260_20
Pasquali P, Sonthalia S, Moreno-Ramirez D, et al. Teledermatology and its current perspective. Indian Dermatol Online J 2020 Jan 13;11(1):12-20. DOI: https://doi.org/10.4103/idoj.IDOJ_241_19
Unhealthy states UP, Bihar and others must prioritise wellness (2021). Available at: https://www.tribuneindia.com/news/editorials/unhealthy-state accessed 15 June 2022.
India-EU Cooperation in the SDG Era: Unlocking the potential of a development partnership in transition. (2019). Available at: https://www.researchgate.net/publication/332510872 accessed 15 June 2022.
Altman DG. Practical statistics for medical research. London: Chapman and Hall. (1991)
Delaigue S, Morand JJ, Olson D, Wootton R, Bonnardot L. Teledermatology in low-resource settings: The MSF experience with a multilingual tele-expertise platform. Front Public Health 2014;2:233. DOI: https://doi.org/10.3389/fpubh.2014.0023
Greisman L, Nguyen TM, Mann RE, et al. Feasibility and cost of a medical student proxy-based mobile teledermatology consult service with Kisoro, Uganda, and Lake Atitlán, Guatemala. Int J Dermatol 2015;54(6):685-692. DOI: https://doi.org/10.1111/ijd.1270
Kaddu S, Soyer HP, Gabler G, Kovarik C. The Africa tele dermatology project: preliminary experience with a sub-Saharan teledermatology and e-learning program. J Am Acad Dermatol 2009;61(1):155-1557. DOI: https://doi.org/10.1016/j.jaad.2008.12.007
Weinberg J, Kaddu S, Gabler G, Kovarik C. The African tele dermatology project: Providing access to dermatologic care and education in sub-Saharan Africa. Pan Afr Med J 2009;3:16. PMID: 21532725.
Madu PN, Chang AY, Kayembe MK, Kovarik CL. Teledermatology as a means to provide multispecialty care: A case of global specialty collaboration. Pediatr Dermatol 2017;34(2):e89-e92. DOI: https://doi.org/10.1111/pde.13079
Su MY, Das S. Expansion of asynchronous teledermatology during the COVID-19 pandemic. J Am Acad Dermatol 2020;83(6):e471-e472. DOI: https://doi.org/
Shin H, Kim DH, Ryu HH, Yoon SY, Jo SJ. Teledermatology consultation using a smartphone multimedia messaging service for common skin diseases in the Korean army: a clinical evaluation of its diagnostic accuracy. J Telemed Telecare 2014;20(2):70-74. DOI: https://doi.org/10.1177/1357633X14524151
Börve A, Holst A, Gente-Lidholm A, Molina-Martinez R, Paoli J. Use of the mobile phone multimedia messaging service for teledermatology. J Telemed Telecare 2012;18(5):292-296. DOI: 10.1258/jtt.2012.120206.
Kaliyadan F, Ashique KT. Use of mobile applications in Dermatology. Indian J Dermatol 2020;65(5):371-376. DOI: https://doi.org/10.4103/ijd.IJD_422_20
Telemedicine practice guidelines enabling registered medical practitioners to provide healthcare using telemedicine (2020). Available at https://www.mohfw.gov.in/pdf/Telemedicine.pdf accessed 20 October 2022
Opperman CJ, Vuren MJ. WhatsApp in a clinical setting: The good, the bad and the law. S Afr J Bioeth Law 2018;11(2):102-103 DOI: https://doi.org/10.7196/SAJBL.2018.v11i2.00643
Morris C, Scott RE, Mars M. WhatsApp in clinical practice-The challenges of record keeping and storage. A scoping Review. Int J Environ Res Public Health 2021;18(24):13426. DOI: https://doi.org/10.3390/ijerph182413426
Bose J. Hindustan Times. WhatsApp empowers 500 villages in India with access to digital payments (2021). Available at: https://www.hindustantimes.com/india-news/whatsapp-empowers-500-villages-in-india-with-access-to-digital-payments-101639546782135.html accessed 5 April 2022.
Ismail A, Stoff BK, McMichael JR. Store-and-forward teledermatology service for primary care providers in Afghanistan. Int J Dermatol 2018;57(11):e145-e147. DOI: https://doi.org/10.1111/ijd.14165
Holmes AN, Chansky PB, Simpson CL. Teledermatology consultation can optimize treatment of cutaneous disease by non-dermatologists in under-resourced clinics. Telemed J E Health 2020;26(10):1284-1290. DOI: https://doi.org/ 10.1089/tmj.2019.0217
G Bianchi M, Santos A, Cordioli E. Benefits of tele dermatology for geriatric patients: Population-based cross-sectional study. J Med Internet Res 2020;22(4):e16700. DOI: https://doi.org/10.2196/16700
Kaliyadan F, Amin TT, Kuruvilla J, Ali WH. Mobile teledermatology--patient satisfaction, diagnostic and management concordance, and factors affecting patient refusal to participate in Saudi Arabia. J Telemed Telecare 2013;19(6):315-319. DOI: https://doi.org/10.1177/1357633X13501778
Nami N, Massone C, Rubegni P, et al. Concordance and time estimation of store-and-forward mobile teledermatology compared to classical face-to-face consultation. Acta Derm Venereol 2015;95(1):35-39. DOI: https://doi.org/10.2340/00015555-1876
Nelson CA, Takeshita J, Wanat KA, et al. Impact of store-and-forward (SAF) teledermatology on outpatient dermatologic care: A prospective study in an underserved urban primary care setting. J Am Acad Dermatol 2016;74(3):484-490.e1. DOI: https://doi.org/10.1016/j.jaad.2015.09.058
Bakhtiar M, Elbuluk N, Lipoff JB. The digital divide: How COVID-19's telemedicine expansion could exacerbate disparities. J Am Acad Dermatol 2020;83(5):e345-e346. DOI: https://doi.org/10.1016/j.jaad.2020.07.043.33
Yeboah CB, Harvey N, Krishnan R, Lipoff JB. The impact of COVID-19 on tele dermatology: A review. Dermatol Clin 2021;39(4):599-608. DOI: https://doi.org/10.1016/j.det.2021.05.007.34 .
Maddukuri S, Patel J, Lipoff JB. Teledermatology addressing disparities in health care access: A review. Curr Dermatol Rep 2021;10(2):40-47. DOI: https://doi.org.1007/s13671-021-00329-2.3535
Giavina-Bianchi M, Santos AP, Cordioli E. Teledermatology reduces dermatology referrals and improves access to specialists. EClinicalMedicine 2020;29:100641. DOI: https://doi.org/10.1016/j.eclinm.2020.100641
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