Figure 1. Reasons for not practicing teledermatology. Bubble indicates median rank; error bars, interquartile range.
Figure 2. Importance of incentives. Bubble indicates median rank; error bars, interquartile range.
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Armstrong AW, Kwong MW, Chase EP, Ledo L, Nesbitt TS, Shewry SL. Why Some Dermatologists Do Not Practice Store-and-Forward Teledermatology. Arch Dermatol. 2012;148(5):649–650. doi:10.1001/archdermatol.2012.42
Author Affiliations: Department of Dermatology (Drs Armstrong and Chase and Ms Ledo) and Vice Chancellor/Dean's Office (Dr Nesbitt), University of California, Davis School of Medicine, Sacramento, California; Center for Connected Health Policy, Sacramento (Mss Kwong and Shewry).
Numerous studies comparing store-and-forward (S&F) teledermatology with conventional, face-to-face care have shown several advantages of S&F teledermatology, including improved patient access, comparable diagnostic accuracy, cost-effective care, and remote medical education.1-3 However, despite these reported benefits of teledermatology in the medical literature, the pace of adoption for S&F teledermatology in the United States has not been as rapid as it might be.
Perception of teledermatology by dermatologists who do not practice it is unknown in the United States. This is an important area of investigation because the findings could help identify areas of opportunity to increase teledermatology adoption in the dermatology community at large.
This study was approved by the institutional review board at the University of California Davis. The Center for Connected Health Policy provided the research team with a list of board-certified dermatologists. Using a multi-pronged approach, we sought to identify all California dermatologists not practicing teledermatology. From September 2010 to March 2011, we randomly surveyed these dermatologists to ask why they did not practice teledermatology.
Of the 120 questionnaires distributed, 26 (21.6%) were returned. The responding dermatologists reported their level of agreement with reasons for not practicing teledermatology by ranking them 1 (disagree strongly) through 6 (agree strongly) (Figure 1).
The dermatologists cited the following 2 top reasons for not practicing S&F teledermatology: (1) lack of understanding of teledermatology reimbursement (median rank, 6.0; interquartile range [IQR], 5.0-6.0); and (2) significantly increased medical-legal risk that teledermatology might impose on their practice, compared with in-person treatment (median rank, 6.0; IQR, 5.0-6.0). The dermatologists reported moderate agreement with the following reasons for not practicing teledermatology: lack of understanding of setup requirements (median rank, 5.0; IQR, 3.3-6.0) and potentially lower teledermatology reimbursements (median rank, 5.5; IQR, 4.0-6.0). Lack of in-person interaction was the reason least cited by the respondents for not practicing teledermatology.
In addition to inquiring into reasons why dermatologists did not practice teledermatology, we asked the dermatologists to assess incentives for them to practice teledermatology. The level of importance was evaluated on a Likert scale from 1 (very unimportant) through 6 (very important) (Figure 2).
The respondents reported the following 4 factors to be very important incentives for them to practice teledermatology: (1) being trained in reimbursement; (2) receiving reimbursement similar to that received for in-person treatment; (3) being informed about the legal risks involved in teledermatology practices; (4) being assured that the medical-legal risks are not greater for teledermatology than they are for in-person visits.
To our knowledge, this is the first survey to investigate dermatologists' stated reasons for not practicing teledermatology and potential incentives for encouraging future participation. By studying these dermatologists, we identified barriers in California to providing teledermatology services and incentives to galvanize the dermatology workforce to participate in teledermatology. Adoption of new health policies that address the perceived barriers to teledermatology and provide incentives for provider participation will be important for sustainability of teledermatology practices.
Correspondence: Dr Armstrong, Department of Dermatology, University of California Davis Health System, 3301 C St, Ste 1400, Sacramento, CA 95816 (firstname.lastname@example.org).
Accepted for Publication: December 20, 2011.
Author Contributions: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Armstrong, Kwong, Nesbitt, and Shewry. Acquisition of data: Armstrong, Ledo, Nesbitt, and Shewry. Analysis and interpretation of data: Armstrong, Chase, Ledo, Nesbitt, and Shewry. Drafting of the manuscript: Armstrong and Chase. Critical revision of the manuscript for important intellectual content: Armstrong, Kwong, Chase, Ledo, Nesbitt, and Shewry. Statistical analysis: Armstrong, Chase, Ledo, and Nesbitt. Obtained funding: Armstrong, Kwong, Nesbitt, and Shewry. Administrative, technical, and material support: Armstrong, Kwong, Nesbitt, and Shewry. Study supervision: Armstrong.
Financial Disclosure: None reported.
Funding/Support: This study was funded by California HealthCare Foundation and Center for Connected Health Policy.
Additional Contributions: We acknowledge the following physicians for their participation in the project: Jeffrey Benabio, MD, Melvin Chiu, MD, William J. Coffey, MD, Kelly Cordoro, MD, Noah Craft, MD, Eileen Crowley, MD, Haines Ely, MD, Ilona Frieden, MD, Eric Fromer, MD, Marc Goldyne, MD, Michael Kolodney, MD, Ivy Lee, MD, Toby Maurer, MD, Dennis Oh, MD, Abel Torres, MD, and David Wong MD. We thank Marc Goldyne, MD, for his valuable insights and guidance regarding the design of this project and Amber Harrison for her administrative support of this project.