BT21: Virtual clinics in teledermatology: an opportunity for all?

J. Hayre and M. Sharma

University of Nottingham, Nottingham, UK

The COVID-19 pandemic has been a catalyst in the slow-moving transition to telemedicine services: dermatology has been particularly affected by this move to ‘teledermatology’ and the use of virtual clinics. However, the COVID-19 pandemic has also exposed and exacerbated pre-existing health inequalities. Dermatological services are prone to inequalities in service access, disease burden and equity. There are 13 million general practice consultations for skin conditions every year (https://www.nottingham.ac.uk/research/groups/cebd/documents/hcnaskinconditionsuk2009.pdf), yet only 611 dermatology consultants provide specialist care (https://www.statista.com/statistics/594431/dermatologists-in-the-united-kingdom-uk-by-staff-grade/). Teledermatology with the adoption of virtual clinics has the potential to increase accessibility to dermatology patients in geographically isolated areas. However, access and use of virtual clinics for dermatology patients poses several challenges. In 2018, five million people in the UK were non-internet users (https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/articles/exploringtheuksdigitaldivide/2019-03-04). A geographical divide exists in the UK concerning knowledge and application of basic digital skills, with the North, the Midlands and Wales falling short in a national average of 79%. The Department for Work and Pensions has impairment listings on a range of skin conditions that are most likely to be disabling (https://www.gov.uk/government/publications/medical-guidance-for-dla-and-aa-decision-makers-adult-cases-staff-guide). Yet, 22% of all disabled people lack internet access. Ethnic disparities on the use of pre-existing online healthcare infrastructure like NHS Direct already exist (Cook EJ, Randhawa G, Large S et al. Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare. Int J Equity Health 2014; 13: 99). Cultural factors and those living in overcrowded housing lack the privacy needed for dermatological consultations. With austerity measures, people are unable to afford internet access or good-quality computers to make video calls to talk about their skin problems, making teledermatology an unsuitable alternative. The digital divide also exists across an age gradient, with older people more likely to report not using the internet. Dermatology patients tend to be elderly, with the median age of patients referred being 51 years. With virtual clinics projected to be significant in the future delivery of dermatology services, it would be prudent to mitigate the risks of digital exclusion for our most vulnerable patients and tackle the persisting inequalities.