Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees
Effect of Teledermatology on Access to Dermatology Care Among Medicaid Enrollees
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DOI：
10.1001/jamadermatol.2016.0938
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发表时间：
2016-08-01
期刊：
影响因子：
10.9
通讯作者：
Mehrotra, Ateev
中科院分区：
文献类型：
--
作者：
Uscher-Pines, Lori;Malsberger, Rosalie;Mehrotra, Ateev
重要信息医疗补助计划的参加者接触皮肤科医生等专家的机会往往有限。远程皮肤病学已被推广为一种潜在的解决方案;然而，它对人群水平的护理的影响很少被评估。为了评估远程皮肤病学对接受皮肤病学护理的医疗补助登记者数量的影响，并描述哪些患者最有可能被转诊到远程皮肤病学。和参与者索赔数据，从一个大型的加州医疗补助管理医疗计划，开始提供远程皮肤病学作为一个覆盖的服务在2012年4月进行了分析。该计划在加州的中央谷招募了382801名患者，其中包括108480名新招募的患者，他们在《平价医疗法案》实施后获得了保险。比较了初级保健实践中将患者转诊到远程皮肤科的患者和未转诊到远程皮肤科的患者的皮肤科就诊率。数据收集时间为2012年4月1日至2014年12月31日，评估时间为3月1日至10月15日，2015.主要结局和指标至少看过1次皮肤科医生的患者百分比（包括面对面和远程皮肤科就诊）和皮肤科医生就诊总数结果：在2012年至2014年至少入组1天的382 801例患者中，8614例（2.2%）有1次或多次皮肤科医生就诊。在所有去看皮肤科医生的患者中，48.5%的人通过远程皮肤科接受护理。在新加入医疗补助的患者中，75.7%（1474/1947）的皮肤科医生通过远程皮肤科接受治疗。从事远程皮肤病学的初级保健实践中，访问皮肤科医生的患者比例增加了63.8%（与其他实践中的20.5%相比; P <0.01）。与面对面皮肤科相比，远程皮肤科为17岁以上的年轻患者提供更多服务（2600/4427 [58.7%] vs 1404/4187 [33.5%]），男性患者（1849/4427 [41.8%] vs 1526/4187 [36.4%]），非白人患者（2779/4188 [66.4%] vs 1844/3478 [53.0%]），和无合并症的个体（2464例中1795例[72.8%] vs 3024例中1978例[65.4%]）（所有比较P < .001）。不同环境下管理的条件各不相同;远程皮肤科医生更有可能照顾病毒性皮肤病变和痤疮（7287次访问中的3405次[46.7%]），而皮肤科医生更倾向于治疗牛皮癣和皮肤肿瘤，（27 347次访问中的10 062次[36.8%]）结论和相关性提供远程皮肤科似乎改善了医疗补助登记者获得皮肤科护理的机会，新加入的角色。
IMPORTANCE Access to specialists such as dermatologists is often limited for Medicaid enrollees. Teledermatology has been promoted as a potential solution; however, its effect on access to care at the population level has rarely been assessed.OBJECTIVES To evaluate the effect of teledermatology on the number of Medicaid enrollees who received dermatology care and to describe which patients were most likely to be referred to teledermatology.DESIGN, SETTING, AND PARTICIPANTS Claims data from a large California Medicaid managed care plan that began offering teledermatology as a covered service in April 2012 were analyzed. The plan enrolled 382 801 patients in California's Central Valley, including 108 480 newly enrolled patients who obtained coverage after the implementation of the Affordable Care Act. Rates of dermatology visits by patients affiliated with primary care practices that referred patients to teledermatology and those that did not were compared. Data were collected from April 1, 2012, through December 31, 2014, and assessed from March 1 to October 15, 2015.MAIN OUTCOMES AND MEASURES The percentage of patients with at least 1 visit to a dermatologist (including in-person and teledermatology visits) and total visits with dermatologists (including in-person and teledermatology visits) per 1000 patients.RESULTS Of the 382 801 patients enrolled for at least 1 day from 2012 to 2014, 8614 (2.2%) had 1 or more visits with a dermatologist. Of all patients who visited a dermatologist, 48.5% received care via teledermatology. Among the patients newly enrolled in Medicaid, 75.7% (1474 of 1947) of those who visited a dermatologist received care via teledermatology. Primary care practices that engaged in teledermatology had a 63.8% increase in the fraction of patients visiting a dermatologist (vs 20.5% in other practices; P < .01). Compared with in-person dermatology, teledermatology served more patients younger vs older than 17 years (2600 of 4427 [58.7%] vs 1404 of 4187 [33.5%]), male patients (1849 of 4427 [41.8%] vs 1526 of 4187 [36.4%]), nonwhite patients (2779 of 4188 [66.4%] vs 1844 of 3478 [53.0%]), and individuals without comorbid conditions (1795 of 2464 [72.8%] vs 1978 of 3024 [65.4%]) (P < .001 for all comparisons). Conditions managed across settings varied; teledermatology physicians were more likely to care for viral skin lesions and acne (3405 of 7287 visits [46.7%]), whereas in-person dermatologists were more likely to care for psoriasis and skin neoplasms (10 062 of 27 347 visits [36.8%]).CONCLUSIONS AND RELEVANCE The offering of teledermatology appeared to improve access to dermatology care among Medicaid enrollees and played an especially important role for the newly enrolled.