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Feasibility of store-and-forward teledermatology in out-patient care: A prospective study from rural India utilising specialist referral services through an instant messaging platform - "WhatsApp"

Lookup NU author(s): Melvin JoyORCiD

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Abstract

Objectives: The COVID-19 pandemic has placed unprecedented demands on the delivery of health care in rural areas of India. We examined the feasibility of store-and-forward mobile teledermatology for outpatient access to specialist dermatologic care in underserved areas in India. Methods: We conducted a prospective study using smartphone-based teledermatology, connecting six underserved clinics manned by primary care physicians (PCP) to three dermatologists, using the instant messaging platform WhatsApp. We assessed the concordance between PCPs and dermatologists (using prevalence adjusted bias adjusted kappa), consultation time, the spectrum of conditions, and the outcome. Results: Of the 730 dermatology patients screened in the clinics, 95 (13%) (36 males and 59 females) required teleconsultation, among which 61.1% were non-infective, 34.7% were infective, and the diagnosis could not be ascertained in 4.2 %. The mean time taken for the first response was 13.5±18.4 minutes. Twenty per cent (n=19) required referral, and 80% (n=76) of consultations could be resolved at the clinic, of whom 36.8 % were cured, 38.2% had moderate, 4% had minimal improvement, 13% were lost to follow-up, and 8% refused treatment. Cure was observed in viral infections and eczema. The diagnostic concordance ranged from low values [0.38 (95% CI: 0-0.68)] in infective to moderate [0.66 (95% CI: 0.42 -0.83), p=0.033] in non-infective disorders. Conclusion: Asynchronous mobile teledermatology, using specialist referral via instant messaging platforms, is a powerful modality for providing real-time dermatologic care, while offering a very promising alternative for decreasing healthcare disparities and continuity of services even in adverse situations like the Covid-19 pandemic.

Publication metadata

Author(s): Thomas M, Chiramel M, Priyanka M, Singh M, Ponraj L, Devakumar K, Balan F, Joseph A, Joy M, Jeyaseelan L, George R

Publication type: Article

Publication status: Published

Journal: Journal of the International Society for Telemedicine and EHealth

Year: 2022

Volume: 10

Issue: e2

Pages: 1-9

Online publication date: 24/12/2022

Acceptance date: 01/11/2022

ISSN (electronic): 2308-0310

Publisher: International Society for Telemedicine & eHealth

URL: https://journals.ukzn.ac.za/index.php/JISfTeH/article/view/2916

DOI: 10.29086/JISfTeH.10.e2

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