Original Title: Evaluación de la implantación de la telemedicina diagnóstica en el ámbito de la dermatología

Authors' objectives: 1. To estimate the diagnostic reliability of teledermatology in this specific experience. 2. To assess the technical operation of the teledermatology system used in this study. 3. To evaluate teledermatology acceptance among medical doctors.

Authors' results and conclusions: Interobserver reliability between the diagnosis issued via teledermatology and the in-person diagnosis expressed in percentages was 73.6% (IC 95%: 67.5% - 78.9%). The overall Kappa index was 0.731 (CI 95%: 0.664 - 0.798). The Kappa index was even higher for skin diseases diagnosed within the seven groups of lesions specified in this study, ĸ = 0.844 (CI 95%: 0.775 - 0.913). On 13 occasions (5.7%), an additional diagnosis was issued following traditional dermatological examination, which could not be diagnosed through the use of teledermatology. The percentage of minor disagreement observed was 4.0% (CI 95%: 2.1% - 7.4%) (9/227), while the percentage of major disagreement observed was 22.5% (IC 95%: 17.5% - 28.3%) (51/227). Following the setting up of the teledermatology service, 257 diagnoses were carried out using this new health care system. The level of confidence in the diagnosis issued using the teledermatology procedure was high in 69.6% of cases. One of the main problems detected following the introduction of the teledermatology activity was the poor quality of the digital images (recorded in 53.3% of the cases diagnosed). However, the image quality did not affect the diagnostic accuracy nor the therapeutic resolution of dermatological problems. The average time period that elapsed from the date of the application for the interconsultation to the date when the dermatologist sent the report to the family doctor was of 4 days. The results of the TAM questionnaire showed that in order to improve the level of acceptance of this new technology among medical doctors, it is necessary to create conditions that facilitate the use of this new diagnostic tool (by providing the necessary infrastructure, training and technical support in order to guarantee the success of the telemedicine activity). Likewise, the results show that teledermatology would be more easily accepted by health professionals if they perceive the usefulness of the new diagnostic tool. Based on the TAM results, 65.4% of the dermatologists interviewed were against teledermatology while 81.4% of primary care professionals were in favour of using this new technology. The χ2 test shows that the intention to use teledermatology depends on the medical speciality and that differences observed were statistically significant with a confidence level of 95%. Our results show that the TAM is a good predictive model of the intention to use teledermatology among health care professionals (Nagelkerke R2 = 0.71 and χ2 is statistically significant). The logistical regression results with the original TAM model variables show that both Perceived Usefulness variable and Perceived Ease of Use variables were statistically significant with Odds Ratios of 8.426 and 7.366, respectively. When other theoretical variables were added, the model was still significant and it also became more powerful (Nagelkerke R2 = 0.78). However, logistical regression results indicated that the only significant predictor in the modified model was Facilitators (training of professionals in the use of the new technology, organisational support and technical assistance) with an Odds Ratio of 9.90.

Authors' methods: The reliability of teledermatology was evaluated using a consecutive sample of 225 patients, with a total of 256 diagnosed dermatological lesions. The diagnostic agreement measurements analysed in this study were the Kappa index and simple concordance expressed in percentages. In order to calculate the Kappa index, 7 groups of lesions were established as categories. The Kappa index was calculated by using SPSS and EPIDAT (Program for the Epidemiological Analysis of Tabulated Data) statistical software. Data relating to the technical operation of the system was gathered by means of the teledermatology computer application. In order to assess the acceptance level of teledermatology among health professionals, a Web site questionnaire was developed based on the Technology Acceptance Model (TAM). The questionnaire was distributed to all the dermatologists within the Basque Health Service (Osakidetza) and to family doctors and paediatricians in the inland primary health care region of the province of Bizkaia. The content validity of the questionnaire was assessed by a panel of experts in health technology assesment. The internal consistency of the instrument was measured by calculating Cronbach’s alpha for each theoretical variable used in the model. Differences in the intention to use teledermatology based on the group of professionals were analysed by means of the χ2 test. The model was tested through logistic regression.

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/Implantacion_WEB.PDF

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>