Teledermatology May Benefit Marginalized Populations: National and Institutional Trends during the COVID-19 Pandemic

Conclusions and Relevance: During the COVID-19 pandemic, certain populations (females, younger patients, non-white races) showed higher teledermatology (TD) utilization. Understanding TD utilization trends is critical in defining the role of virtual care for improving universal care access, optimizing resources, and informing future healthcare models for all patient populations. It is important to understand the utilization of TD during the pandemic for defining how virtual care delivery can improve and optimize both current and future healthcare models to meet the needs of all patient populations. What was learned from the study? During the pandemic, TD utilization was higher among female patients, non-white patients, younger patients, and out-of-state patients. Differential trends in TD utilization were noted, consistent between institutional and national dermatology data, that can be useful for planning future healthcare delivery models. Introduction: Limited data exist regarding demographic-specific teledermatology (TD) utilization during the COVID-19 pandemic. This study aimed to determine TD utilization trends during the pandemic. Methods: A retrospective cohort study using national (American Academy of Dermatology’s DataDerm registry; 1 April 2020–30 June 2021) and institutional (Duke University Health System, DUHS; 1 March 2020–30 April 2021) datasets. Encounters were categorized as TD vs in-person and stratified by sex, race, age/generation, and location (in- vs out-of-state; national only). Institutional no-show rates were also assessed. TD utilization was defined as the cohort of interest using TD within a demographic group as a percentage of total TD users and compared to in-person utilization in the same timeframe. Chi-square tests with Bonferroni-adjusted p-values were used. Results: Nationally, 13,964,816 encounters were analyzed; sex, race, age, and location were significantly associated with TD utilization (adjusted p < 0.001). Institutionally, 54,400 encounters were analyzed; sex, race, and age were significantly associated with TD utilization (adjusted p < 0.001). Females comprised the majority of TD visits (DataDerm 66.0%; DUHS 61.7%). Non-white populations accounted for a higher percentage of TD utilizers (DataDerm 15.0%; DUHS 37.3%) vs in-person (DataDerm 11.7%; DUHS 22.3%). Younger patients used TD more than in-person (DataDerm age ≤40: 63.6% vs 26.3%; DUHS younger generations: 62.6% vs 43.8%). Institutional no-show rates were lower for TD vs in-person among Black patients (11.8% vs 19.2%) and younger ages/generations (9.8% vs 12.8%). TD utilization decreased over time as a percentage of total visits nationally (2.9% in 2020 vs 0.3% in 2021).

Akash D Patel, W Chandler Rundle, Liu Beiyu, L Cynthia Green, L Christian Bailey-Burke, Meenal Kheterpal