Access Hero: Improving access to dermatology for underserved patients in Philly

Cory Simpson

By Cory Simpson, MD, PhD, University of Pennsylvania

Unfortunately, for uninsured and underserved patients, access to a dermatologist is especially limited. Often, demand is high and clinics are overstretched in both appointment availability and resources. At our Philadelphia clinic, Puentes de Salud, we implemented a teletriage program to improve access to dermatology. We recently conducted a retrospective study to assess the program and found we achieved three improvements: reduced time to consultation, refined diagnosis and treatment plans, and increased in-person appointment availability.

Dr. Simpson uses teledermatology to see more patients at a clinic for an underserved population. Read more.

Most patients at Puentes de Salud are immigrants with no insurance who also face cultural, language, and financial barriers to receiving care. Patients are matched with a primary care physician who oversees their care and determines if they need to be seen by specialists. Local dermatologists volunteer to support one clinic per month, but the volume of dermatology referrals regularly exceeds capacity, which resulted in long wait times and delayed patient care.

To improve our ability to meet high demand in a timely manner, we implemented a teledermatology program. The program was established using the American Academy of Dermatology’s teledermatology smartphone application, AccessDerm, which allows primary care providers who work in participating clinics to submit consultations with photos to volunteer dermatologists.

In our study, we requested that all new dermatology referrals undergo an AccessDerm consultation before scheduling in-person visits. Dermatologists reviewed the cases remotely and could either make recommendations based on photos or defer to an in-person visit when necessary for either diagnostic certainty or the need for a procedure including biopsies, injections, cryodestruction, or electrodessication, all of which we can perform at the clinic.

Our retrospective study evaluated all of our teledermatology consultations from 2014 to 2016, and found that by implementing this teletriage program, we reduced the time to a dermatologic consultation from more than 14 days to one day or less. Strikingly, we also found that though 23 percent of referring providers submitted the same differential diagnosis as the consulting teledermatologist, the teledermatologist suggested a management change in 95 percent of the cases. Additionally, the teletriage system saved our clinic an average of 1.4 of 8 appointments per clinic, increasing in-person appointment availability by 18 percent.

The teledermatology program at Puentes de Salud is an effective triage system in a resource-limited clinic, as seen in the results of our study, emphasizing the positive impact of teletriage on access to care. We are now able to see more patients, collaborate with primary care providers to educate them about dermatologic diagnoses and treatment plans, and prioritize which patients need to be seen in-person by a dermatologist. Read more about the Puentes de Salud teledermatology program and see the results of our study in the November issue of the Journal of the American Academy of Dermatology. We hope these promising results inspire volunteerism and encourage our peers to utilize teledermatology to help improve care for disadvantaged populations, who can truly benefit from our expertise in cutaneous disease.