Linking dermatologists to patients in remote areas through tele-medicine gives patients more accurate diagnoses and better disease management than they would receive without access to a specialist, says a study in the January Archives of Dermatology.

Researchers analyzed data from 1,490 patients who had tele-dermatology consultations and found that patients received a diagnosis that was different from the referring physician's in 70% of cases. In 98% of cases, dermatologists recommended changes in the way patients were managing their condition.

"We were more surprised that a lot of these changes in management did lead to an improvement in their disease," said study co-author April W. Armstrong, MD, MPH, director of tele-dermatology at the University of California Davis School of Medicine. "The changes in management and the changes in diagnosis really correlated with patients' improvement."

Improved clinical outcomes were seen for 69% of 313 patients who had at least one follow-up visit within a year, the study said. Patients who had their diagnosis changed in the initial consultation were about two times more likely to show clinical improvement in future visits compared with patients whose diagnosis did not change.

Patients in the study ranged from 3 months to 88 years old. They all had a live, interactive tele-medicine visit with a dermatologist at UC Davis between 2003 and 2005.

Researchers hope the study will help educate dermatologists, family physicians and other primary care professionals about how tele-medicine can benefit their patients, said Dr. Armstrong, who directs the university's dermatology clinical research unit. Tele-medicine is used increasingly to connect dermatologists and other specialists with patients in remote, medically under-served areas.

"This information will appeal to a lot of primary care physicians, especially those who feel that they can't get a patient to see a dermatologist in a timely manner," she said.

About 40 dermatology programs in the U.S. use tele-medicine. The most common form of tele-dermatology is known as "store and forward," in which details about the patient are recorded and sent to a specialist to review later. Live tele-dermatology requires more schedule coordination, but it provides real-time interaction between patients and physicians, the study said.

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