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Direct-to-Consumer Dermatology Telemedicine Value Unclear

Concerns raised in relation to skin disease diagnosis and treatment by many telemedicine websites

WEDNESDAY, May 18, 2016 (HealthDay News) — Use of direct-to-consumer (DTC) telemedicine is associated with questionable quality of skin disease diagnosis and treatment, according to a study published online May 16 in JAMA Dermatology.

Jack S. Resneck Jr., M.D., from the University of California in San Francisco, and colleagues examined the performance of DTC teledermatology services. Simulated patients submitted a series of structured dermatologic cases with photographs using DTC telemedicine websites and smartphone apps.

The researchers received responses for 62 clinical encounters from 16 DTC telemedicine websites. None asked for identification, and there were no concerns raised about pseudonym use or falsified photographs. Patients were assigned a clinician without any choice in 68 percent of encounters. Twenty-six percent of clinicians disclosed information about clinician licensure and some used internationally based physicians without local licenses. Twenty-three percent collected the name of a physician and 10 percent offered to send records. In 77 percent of encounters a diagnosis or likely diagnosis was proffered. In 65 percent of diagnosed cases prescription medications were ordered; relevant adverse effects or pregnancy risks were disclosed in 32 and 43 percent, respectively. Several correct diagnoses were made by websites where photographs alone were adequate, but diagnostic performance was poor when basic additional history elements were important. Major diagnoses were repeatedly missed.

“Our findings, however, raise concerns about the quality of skin disease diagnosis and treatment provided by many DTC telemedicine websites,” the authors write.

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