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Effect of Store and Forward Teledermatology on Quality of Life:  A Randomized Controlled Trial

John D. Whited, MD, MHS; Erin M. Warshaw, MD, MS; Karen E. Edison, MD; Kush Kapur, PhD; Lizy Thottapurathu, MS; Srihari Raju, MD; Bethany Cook, MD; Holly Engasser, MD; Samantha Pullen, MD; Patricia Parks, CMA; Tom Sindowski, BS; Danuta Motyka, BS; Rodney Brown, BS; Thomas E. Moritz, MS; Santanu K. Datta, MBA, PhD; Mary-Margaret Chren, MD; Lucinda Marty, DO; Domenic J. Reda, PhD
JAMA Dermatol. 2013;149(5):584-591. doi:10.1001/2013.jamadermatol.380.
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Importance Although research on quality of life and dermatologic conditions is well represented in the literature, information on teledermatology's effect on quality of life is virtually absent.

Objective To determine the effect of store and forward teledermatology on quality of life.

Design Two-site, parallel-group, superiority randomized controlled trial.

Setting Dermatology clinics and affiliated sites of primary care at 2 US Department of Veterans Affairs medical facilities.

Participants Patients being referred to a dermatology clinic were randomly assigned, stratified by site, to teledermatology or the conventional consultation process. Among the 392 patients who met the inclusion criteria and were randomized, 326 completed the allocated intervention and were included in the analysis.

Interventions Store and forward teledermatology (digital images and a standardized history) or conventional text-based consultation processes were used to manage the dermatology consultations. Patients were followed up for 9 months.

Main Outcome Measures The primary end point was change in Skindex-16 scores, a skin-specific quality-of-life instrument, between baseline and 9 months. A secondary end point was change in Skindex-16 scores between baseline and 3 months.

Results Patients in both randomization groups demonstrated a clinically significant improvement in Skindex-16 scores between baseline and 9 months with no significant difference by randomization group (P = .66, composite score). No significant difference in Skindex-16 scores by randomization group between baseline and 3 months was found (P = .39, composite score).

Conclusions Compared with the conventional consultation process, store and forward teledermatology did not result in a statistically significant difference in skin-related quality of life at 3 or 9 months after referral.

Trial Registration clinicaltrials.gov Identifier: NCT00488293

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Figure. Participant enrollment diagram. Eligibility assessments at Minneapolis included a review of all incoming electronic consults for eligibility, whereas the Columbia site could not use that same mechanism. Eligibility assessments at Columbia required interaction with potential participants. Other reasons for exclusion included inability to follow up with the potential participant after the consultation was placed to determine interest or eligibility. More than one reason for not meeting inclusion criteria was possible among the 271 patients not meeting the inclusion criteria. The patient mislocated to conventional care was excluded from all analyses.




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