Reliability and Validity of Mobile Teledermatology in Human Immunodeficiency Virus-Positive Patients in Botswana A Pilot Study
Reliability and Validity of Mobile Teledermatology in Human Immunodeficiency Virus-Positive Patients in Botswana A Pilot Study
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DOI：
10.1001/jamadermatol.2013.7321
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发表时间：
2014-06-01
期刊：
影响因子：
10.9
通讯作者：
Kovarik, Carrie L.
中科院分区：
文献类型：
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作者：
Azfar, Rahat S.;Lee, Robert A.;Kovarik, Carrie L.
重要性 移动远程皮肤科可增加获得护理的机会。目的 确定与面对面皮肤科咨询相比，博茨瓦纳哈博罗内的人类免疫缺陷病毒 (HIV) 阳性患者的移动远程皮肤科是否可靠并产生有效的评估。设计、设置和参与者 在博茨瓦纳的门诊诊所和公立住院机构中对 76 名 18 岁及以上 HIV 阳性患者进行了横断面研究患有未经皮肤科医生评估的皮肤或粘膜疾病。主要结果和措施我们计算了。诊断系数、诊断类别以及重测和评估者间可靠性的管理。我们还确定了每个诊断的敏感性和特异性。结果。初次诊断的重测信度系数范围为 0.47（95% CI，0.35 至 0.59）至 0.78（0.67 至 0.88），诊断类别的范围为 0.29（0.18 至 0.42）至 0.73（0.61 至 0.84），诊断类别的范围为 0.17（-0.01 至 0.36）。 0.54（0.38 至 0.70）用于管理。这。初步诊断的评估者间可靠性系数范围为 0.41（95% CI，0.31 至 0.52）至 0.51（0.41 至 0.61），诊断类别的范围为 0.22（0.14 至 0.31）至 0.43（0.34 至 0.53），诊断类别的范围为 0.08（0.02 至 0.15）。 0.12（0.01 至 0.23）用于管理。前 10 名诊断的敏感性和特异性分别为 0 至 0.88 和 0.84 至 1.00。 结论和相关性 我们的结果表明，虽然在博茨瓦纳的 HIV 阳性患者中使用移动远程皮肤科技术具有改善护理机会的巨大潜力，但还需要开展额外的工作来在该人群中更大规模地提高该技术的可靠性和有效性。
IMPORTANCE Mobile teledermatology may increase access to care.OBJECTIVE To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist.MAIN OUTCOMES AND MEASURES We calculated the. coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis.RESULTS The. coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The. coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively.CONCLUSIONS AND RELEVANCE Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.