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Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform.

Delaigue S, Morand JJ, Olson D, Wootton R, Bonnardot L - Front Public Health (2014)

Bottom Line: The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period.Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Department, Hopital Nord , Marseille , France.

ABSTRACT

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.

Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.

Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7-21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26-3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.

Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

No MeSH data available.


Related in: MedlinePlus

Dermatology photography recommendations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4231841&req=5

Figure 9: Dermatology photography recommendations.

Mentions: Establish picture standards. Fifteen percent of the attached pictures were considered by experts as of poor quality. Picture quality is crucial to reliable teledermatology diagnosis (21). Many studies have shown that when teledermatology relies on pictures of good quality it can deliver the same diagnosis that proper physical examination does in most cases (22). As with a face to face examination, pictures should represent the whole patient before providing close-ups of the primary lesion (23). As a standard, referrers should attach at least two pictures to all dermatology cases referred (one close-up, the other one an overview). Some classic general recommendations to standardize attached pictures are given in Figure 9.


Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform.

Delaigue S, Morand JJ, Olson D, Wootton R, Bonnardot L - Front Public Health (2014)

Dermatology photography recommendations.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231841&req=5

Figure 9: Dermatology photography recommendations.
Mentions: Establish picture standards. Fifteen percent of the attached pictures were considered by experts as of poor quality. Picture quality is crucial to reliable teledermatology diagnosis (21). Many studies have shown that when teledermatology relies on pictures of good quality it can deliver the same diagnosis that proper physical examination does in most cases (22). As with a face to face examination, pictures should represent the whole patient before providing close-ups of the primary lesion (23). As a standard, referrers should attach at least two pictures to all dermatology cases referred (one close-up, the other one an overview). Some classic general recommendations to standardize attached pictures are given in Figure 9.

Bottom Line: The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period.Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

View Article: PubMed Central - PubMed

Affiliation: Dermatology Department, Hopital Nord , Marseille , France.

ABSTRACT

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.

Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.

Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7-21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26-3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.

Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

No MeSH data available.


Related in: MedlinePlus