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PLoS One. 2018 Sep 24;13(9):e0204545. doi: 10.1371/journal.pone.0204545. eCollection 2018.

Tele-expertise for diagnosis of skin lesions is cost-effective in a prison setting: A retrospective cohort study of 450 patients.

Author information

1
URC Eco Ile-de-France, AP-HP, Paris, France.
2
Department of Public Health, Henri Mondor-Albert Chenevier Hospitals, AP-HP, Créteil, France.
3
Department of Dermatology, Victor Dupouy Hospital, Argenteuil, France.
4
Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Paris France.
5
André Mignot Hospital, Versailles, France.
6
Faculty of Medicine, University Paris-Est Créteil, Créteil, France.

Abstract

CONTEXT:

The prevalence of skin diseases among prisoners is higher than in the general population. Diagnosing and treating these lesions require a dermatologic advice. A tele-expertise network in dermatology for prisoners including 8 health facilities in prison and 2 hospital dermatological departments was developed to improve access to dermatologists' expertise in correctional facilities. Our objective was to evaluate the effectiveness and costs of tele-expertise in dermatology for prisoners.

METHODS:

We carried out a retrospective cohort study on data collected by the information system of the tele-expertise network. We used the MAST (Model for ASsessment of Telemedicine) model to perform a multidimensional assessment including the proportion of patients with a completed treatment plan for the skin lesions, the proportion of technical problems, the quality of the pictures, the investment and operating costs and the satisfaction of the professionals.

RESULTS:

Mean patient age was 34.2 years with 90% men. 511 requests for 450 patients were initiated. The delay from the connection to the tele-expertise software to the validation of the request was inferior to 7 min for 50% of the requests and inferior to 30 min for 85% of the requests. Overall, with tele-expertise, 82% of the patients had a completed treatment plan for the skin lesions, with 2.9% of all patients requiring a later face-to-face appointment or hospitalization, to be compared to a proportion of 35% of patients with a completed treatment plan when tele-expertise was not available. The most frequent lesions were acnea (22%) and atopic dermatitis (18%). The mean cost for one completed treatment plan was €184 by tele-expertise and €315 without tele-expertise. Tele-expertise was well accepted among physicians with all responders (n = 9) willing to continue using it.

CONCLUSION:

Tele-expertise is a dominant intervention in comparison to a face-to face consultation taking into account the cost of transportation and the proportion of canceled appointments and is acceptable for physicians.

TRIAL REGISTRATION:

NCT02309905.

PMID:
30248151
PMCID:
PMC6152874
DOI:
10.1371/journal.pone.0204545
[Indexed for MEDLINE]
Free PMC Article

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