Increasing access to underserved populations
Upon moving to Philadelphia for my dermatology residency, I was very excited to learn the dermatology residents and attending physicians at Penn Dermatology staffed a monthly evening clinic at Puentes de Salud, a clinic that provides free care to a mostly Spanish-speaking population.
Patients at the clinic are typically immigrants with no insurance who face cultural, language, and financial barriers to receiving health care. Patients are matched with a primary care provider, who oversees their care and determines if they need to be seen by specialists. If they need a dermatologist, the provider will schedule them into our clinic or they can be triaged through the American Academy of Dermatology’s teledermatology smartphone application, which sends photos and clinical information to the dermatologists who volunteer their expertise for the program at Penn.
Through teledermatology, we are effectively able to see more patients and save appointments for people who have more serious conditions or have failed their first round of treatment. After implementing the teledermatology system, we saved an average of 1.4 of 8 appointments per clinic—resulting in an 18 percent increase in appointment availability.
Additionally, we found that we can build upon primary providers’ proposed treatment plans and educate them about dermatologic therapies. Although 23% of referring providers submitted the same differential diagnosis as the consultant, the teledermatologist suggested a management change in 95% of the cases, which underscores the importance of specialist input for skin conditions that are often painful, disfiguring, stigmatizing, and even disabling patients from employment.
Moreover, since we offer in-person appointments, we have the ability to follow up with patients evaluated by teledermatology as needed. Also, we can perform minor procedures, including biopsies, and even offer charity pathology services to those of limited means. This has allowed us to diagnose and manage various conditions ranging from lichen planus to cicatricial pemphigoid to basal cell carcinomas, and even a case of Reed syndrome in which the photographed lesions indicated a genetic cancer susceptibility.
Working at Puentes de Salud has given me the opportunity to utilize both my dermatologic and Spanish language skills to provide care to a population that otherwise would not have access to our expertise in cutaneous disease.
“Through teledermatology, we are effectively able to see more patients, recommend treatment plans, and determine which patients will need to be seen in person by a dermatologist. This allows us to keep spots open for the monthly clinic, saving those appointments for people who have more serious conditions or have failed their first round of treatment. Moreover, we have the ability to perform minor procedures including biopsies as needed and offer pathology services from our department, free of charge. This has allowed us to diagnose and manage various dermatologic conditions ranging from lichen planus, to cicatricial pemphigoid, to basal cell carcinomas.”
─ Cory Simpson, MD, PhD, Department of Dermatology, University of Pennsylvania