BT01: A 5-year paediatric teledermatology experience: a retrospective follow-on study
A. Lowe,1,2 S. Whitaker3 and R. Goodwin1
1Department of Dermatology, Royal Gwent Hospital, Newport, Gwent, UK; 2Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK; and 3Department of Dermatology, Swansea Bay University Health Board, Swansea, UK
We present follow-on data from a paediatric teledermatology pilot previously presented at the British Association of Dermatologists meeting in July 2017. A retrospective analysis of the outcomes data from the last 5 years of our store-and-forward paediatric teledermatology referral service was undertaken. A total of 1494 urgent and routine referrals, seen between June 2015 and July 2020, were included. Primary care practitioners decided on suitability for paediatric teledermatology, made an electronic referral and patients/parents attended peripheral medical photography clinics for high-quality images, including dermoscopy, where indicated. All cases were reviewed by a single paediatric dermatologist, with peer review as required. Almost half (43%) the referrals received comprised benign naevi, which was also the most common reason for referral in the original 2017 pilot (44%). Other common groups of diagnoses included inflammatory dermatoses (15%), viral warts and molluscum contagiosum (12%), other benign lesions (12%), vascular lesions (10%), noninflammatory generalized dermatoses (2%), scarring (2%), hair and nail disorders (2%), artefact/anatomical variants (1%), infections and infestations (1%), normal skin (1%) and malignancies (0·3%), with an uncertain diagnosis in 0·4%. Most (69%) were directly discharged without the need for face-to-face (F2F) outpatient review (25%). Repeat photos for lesion monitoring were arranged in 5%, treatment at the day unit in 2%, surgery in 2% and biopsy advised in 1%. A telephone follow-up with a nurse specialist was arranged in 0·5%, open appointments in 0·4% and patch testing undertaken for 0·1%. Direct referrals to other specialties, including plastics, were made in 2%. Interestingly, 76% of patients were diverted from needing to attend clinic F2F, similar to the 2017 pilot (78% diverted). Of note, a higher percentage (25%) of our paediatric teledermatology cohort necessitated booking-in for F2F review vs. our adult inflammatory (13%) or lesional (14%) teledermatology streams, perhaps reflecting a greater need for parental reassurance in paediatric telemedicine. Waiting times were reduced to 8 weeks overall, with 2-week waits for urgent referrals. Patient and primary care satisfaction with our medical photography teledermatology service was high, in general, although this was not assessed separately for our paediatric cohort. The service was also cost-effective, with savings of £56 per patient, translating to approximately £64 120 over 5 years. There are limited long-term data focusing on paediatric teledermatology and our follow-on study indicates a successful and sustainable long-term model for both urgent and routine paediatric teledermatology referrals that is acceptable to both patients/parents and primary care practitioners.
