Teledermatology Before, During, and After Covid-19: A Vital Tool to Improve Access and Equity in Specialty Care

Since the onset of the COVID-19 pandemic, telemedicine has rapidly expanded across the nation as medical systems have had to shift to providing care through virtual modalities to ensure the safety of patients and staff. Teledermatology, in particular, is wellsuited for telemedicine, with literature supporting its efficacy, equitable quality and accuracy, and cost-effectiveness in comparison to in-person visits. Teledermatology holds great potential in continuing to increase access to patients and ensuring continuity of care, particularly for those from rural and underserved areas. Although introduced decades ago, the adoption of virtual visits has previously been limited by restrictive coverage policies, lack of reimbursement, and maintenance costs. While the Centers for Medicare and Medicaid Services and most private payers have ensured broad coverage for telehealth since the start of the pandemic, many of these policy changes are temporary and set to expire at the end of the public health emergency. Continued advocacy efforts and future studies highlighting teledermatology’s impact, particularly on minorities and underserved patient populations, are critical for long-term legislative changes to occur and to provide coverage to our most vulnerable patients. In this article, we highlight the state of teledermatology prior to the pandemic, the legislative changes that permitted teledermatology to rapidly expand during the pandemic, and the importance of continued coverage after the pandemic

Telemedicine and the battle for health equity: Translating temporary regulatory orders into sustained policy change

At this moment in the United States, we are battling two of the largest public health crises of our time: the COVID-19 pandemic and systemic racism, which has existed for centuries but recently came into sharper public focus. In tandem, these public health crises mean that the COVID-19 pandemic has placed a disproportionate burden of disease incidence, hospitalizations, and deaths on our most vulnerable communities. As medical professionals, there has never been a more important time to systematically address health equity in policy and practice

Understanding the Impact of Teledermatology on No-Show Rates and Healthcare Accessibility: A Retrospective Chart Review

At the onset of the COVID-19 pandemic, emergency legislation expanding coverage of telehealth service 38 swept across the nation to allow for continued access to medical care despite strict shelter-in-place guidelines. In the wake of this, telehealth usage has increased dramatically. Dermatology, in particular, is uniquely amenable to virtual visits and teledermatology has the potential to become a permanent platform from which we provide specialty care. As telehealth expands, additional data is needed on the impact of telehealth on health equity. Missed appointments, or no-shows, are a measure of health disparity, with low-income, Medicaid, and minority patients traditionally having the highest no-show rates. Given the ability of teledermatology to theoretically improve patient convenience and eliminate potential barriers to care, we sought to investigate the impact of telehealth on no-show rates and patient access at a large academic medical center

Response to the influence of teledermatology on health care access and equity

To the Editor: We thank Hadeler and his co-authors for their support of our research and for providing additional context regarding telemedicine\u27s impact on health care access and equity.Although we found that teledermatology services performed during the COVID-19 pandemic benefitted minority and Medicaid patients, Hadeler et al highlight previous survey-based studies from 2011 and 2013 to 2016 that demonstrated these patients were the least likely to utilize telemedicine. We believe there are 2 key factors that likely contributed to the increased appointment attendance among minority and Medicaid patients found in our study reflecting the rapidly evolving landscape of telemedicine. These factors are also notable, as they have implications for future access to telemedicine

The Impact of Telehealth Implementation on Underserved Populations and No-Show Rates by Medical Specialty During the COVID-19 Pandemic

A unique and sudden need for virtual medical visits created by the coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented expansion of telemedicine across nearly all medical specialties in the United States. In addition to providing essential medical services during the pandemic, telemedicine has the potential to expand health care access to underserved populations by eliminating traditional barriers to care such as transportation needs, distance from specialty providers, and approved time off from work. However, the literature regarding telehealth accessibility for low-income, non-English-speaking, and minority patients remains limited. Through a cross-sectional analysis comparing 2019 clinic visits with 2020 telehealth visits at the UMass Memorial Medical Center, we demonstrate specialty-specific changes in patient demographics, including a younger population, fewer non-English-speaking patients, and a relative preservation of minority, Medicaid, and Medicare patients among telehealth visits in comparison to clinic visits. We also demonstrate that nonsurgical specialties had significantly lower no-show rates and the greatest number of telehealth visits. Overall, our findings highlight the potential shortcomings of telemedicine in servicing non-English-speaking patients, while maintaining that it is an important tool with the potential to improve access to health care, particularly in nonprocedural specialties

Physician values in alopecia areata treatment decision-making: A qualitative assessmentCapsule Summary

Background: Alopecia areata (AA) is a disease of hair loss with multiple treatment options. Physicians play an important role in guiding patients during the decision-making process. Objective: Assess physicians’ values and attitudes when helping patients choose an AA treatment. Methods: Semi-structured qualitative interviews were conducted with dermatologists of varying practice type and location. Each interview was coded independently twice using inductive thematic analysis. Interrater reliability and code frequencies were determined. Results: Fourteen participants were interviewed. Interrater reliability was κ = 0.85 to 0.97. Dermatologists wanted patients to consider various treatment factors (ie, efficacy, safety, convenience of use, accessibility) and also assessed patients’ AA clinical severity and personality traits. Participants often encountered various barriers to effective communication with patients, which may be mitigated by shared decision-making. Shared decision-making tools were perceived to potentially improve patient care and communication, although physicians expressed concern about lack of individualization, limitations of time, and the appropriateness of information. Conclusion: AA treatment decision-making is a complex process that often utilizes the expertise of a dermatologist, during which shared decision-making tools may be of value to both patients and physicians