ABSTRACT
BACKGROUND: Teledermatology is comparable to face-to-face visits in providing accurate diagnoses and effective treatments. However, there are limited data regarding patient satisfaction with teledermatology models that more directly convey provider recommendations to patients. OBJECTIVE: To assess patient satisfaction with the teledermatology service at the Atlanta Veterans Affairs Medical Center (AVAMC). METHODS: A cross-sectional, phone-based questionnaire study of 175 AVAMC teledermatology patients was performed to investigate patient satisfaction. In phase 1 (n = 100), we compared the teleconsultative and telemedicine models. In phase 2 (n = 75), we compared patients who received 1 of 3 possible consult outcomes: reassurance, appointment for biopsy, or appointment for face-to-face evaluation. RESULTS: There were no statistically significant differences in satisfaction between patients who were seen with the telemedicine and teleconsultative models. Patients who received appointments for face-to-face evaluation or biopsy were more satisfied than patients who received reassurance only. Both phases were remarkable for high patient satisfaction among all cohorts. LIMITATIONS: This study was performed at a single Veterans Affairs medical center and is vulnerable to both nonresponse bias and recall bias. CONCLUSION: Overall, patients are satisfied with teledermatology services at the AVAMC. Strong partnership with referring primary care providers and clear delineation of responsibilities is vital to the teledermatology process.
Subject(s)
Dermatology , Skin Diseases , Telemedicine , Veterans , Humans , Patient Satisfaction , Cross-Sectional Studies , Skin Diseases/diagnosisSubject(s)
Incidental Findings , Skin Neoplasms/diagnosis , Telemedicine , Aged , Aged, 80 and over , Dermatology/methods , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
BACKGROUND: Timely treatment for melanoma may affect survival, and characterizing the predictors of delay may inform intervention strategies. OBJECTIVE: To determine characteristics associated with the interval between diagnosis and surgery in melanoma. METHODS: The National Cancer Database was used to examine factors associated with the interval between diagnosis and surgery among 213 146 patients with stage I, II, or III cutaneous melanoma. RESULTS: Among privately insured patients, time to surgery was longer for patients aged 50 to 70 years (hazard ratio [HR], 0.96) and older than 70 years (HR, 0.83) compared with those younger than 50 years. In contrast, patients without private insurance experienced a shorter surgical wait time if older (HR for age 50-70 years, 1.07; HR for age >70 years, 1.05). Other factors associated with longer surgical interval included nonwhite race, less education, higher comorbidity burden, advanced stage, and head or neck melanoma location. LIMITATIONS: Use of zip code-level data for income and education level. CONCLUSION: Patients with melanoma experience disparities in timely receipt of surgery.
