Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014

array:24 ["pii" => "S1578219018302245" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.06.013" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1957" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:624-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 127 "formatos" => array:2 [ "HTML" => 119 "PDF" => 8 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018301820" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.03.015" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1957" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:624-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 431 "formatos" => array:2 [ "HTML" => 243 "PDF" => 188 ] ] "es" => array:14 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Modelos de práctica de la teledermatología en España. Estudio longitudinal 2009-2014" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:3 [ 0 => "es" 1 => "es" 2 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "624" "paginaFinal" => "630" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 1 "multimedia" => array:5 [ "identificador" => "fig0020" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 937 "Ancho" => 1333 "Tamanyo" => 90419 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Romero, D. de Argila, L. Ferrandiz, M.P. Sánchez, S. Vañó, R. Taberner, P. Pasquali, C. de la Torre, F. Alfageme, J. Malvehy, D. Moreno-Ramírez" "autores" => array:11 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Romero" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "de Argila" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Ferrandiz" ] 3 => array:2 [ "nombre" => "M.P." "apellidos" => "Sánchez" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Vañó" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Taberner" ] 6 => array:2 [ "nombre" => "P." "apellidos" => "Pasquali" ] 7 => array:2 [ "nombre" => "C." "apellidos" => "de la Torre" ] 8 => array:2 [ "nombre" => "F." "apellidos" => "Alfageme" ] 9 => array:2 [ "nombre" => "J." "apellidos" => "Malvehy" ] 10 => array:2 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Graphical abstract" "clase" => "graphical" "resumen" => "<elsevierMultimedia ident="fig0020"></elsevierMultimedia>" ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219018302245" "doi" => "10.1016/j.adengl.2018.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302245?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018301820?idApp=UINPBA000044" "url" => "/00017310/0000010900000007/v1_201809020415/S0001731018301820/v1_201809020415/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219018302336" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.06.021" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1950" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:631-42" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "631" "paginaFinal" => "642" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo de la psoriasis moderada-grave en condiciones de práctica habitual en el ámbito hospitalario español" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1429 "Ancho" => 2052 "Tamanyo" => 193768 ] ] "descripcion" => array:1 [ "en" => "Factors that lead the dermatologists to transition a patient from a traditional systemic treatment to a biologic and to limit the amount of time a patient stays on a traditional systemic therapy. The reasons were ranked on a scale of 1 (least important) to 5 (most important)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.L. López-Estebaranz, P. de la Cueva-Dobao, C. de la Torre Fraga, M. Galán Gutiérrez, E. González Guerra, J. Mollet Sánchez, I. Belinchón Romero" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "de la Cueva-Dobao" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "de la Torre Fraga" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Galán Gutiérrez" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "González Guerra" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Mollet Sánchez" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Belinchón Romero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018301753" "doi" => "10.1016/j.ad.2018.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018301753?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302336?idApp=UINPBA000044" "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302336/v1_201809020417/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1578219018302269" "issn" => "15782190" "doi" => "10.1016/j.adengl.2018.06.015" "estado" => "S300" "fechaPublicacion" => "2018-09-01" "aid" => "1976" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Actas Dermosifiliogr. 2018;109:617-23" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6 "formatos" => array:2 [ "HTML" => 2 "PDF" => 4 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "617" "paginaFinal" => "623" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Descripción de los pacientes que reciben biológicos como primer tratamiento sistémico en el registro BIOBADADERM durante el periodo 2008-2016" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3198 "Ancho" => 1500 "Tamanyo" => 203790 ] ] "descripcion" => array:1 [ "en" => "Withdrawal from treatment." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Carretero Hernández, C. Ferrándiz, R. Rivera Díaz, E. Daudén Tello, P. de la Cueva-Dobao, F.J. Gómez-García, E. Herrera-Ceballos, I. Belinchón Romero, J.L. López-Estebaranz, M. Alsina Gibert, J.L. Sánchez-Carazo, M. Ferrán Farrés, A. González Quesada, J.M. Carrascosa Carrillo, M. Llamas-Velasco, M.V. Mendiola Fernández, D. Ruiz Genao, C. Muñoz Santos, I. García-Doval, M.A. Descalzo" "autores" => array:21 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Carretero Hernández" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Ferrándiz" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Rivera Díaz" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Daudén Tello" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "de la Cueva-Dobao" ] 5 => array:2 [ "nombre" => "F.J." "apellidos" => "Gómez-García" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "Herrera-Ceballos" ] 7 => array:2 [ "nombre" => "I." "apellidos" => "Belinchón Romero" ] 8 => array:2 [ "nombre" => "J.L." "apellidos" => "López-Estebaranz" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Alsina Gibert" ] 10 => array:2 [ "nombre" => "J.L." "apellidos" => "Sánchez-Carazo" ] 11 => array:2 [ "nombre" => "M." "apellidos" => "Ferrán Farrés" ] 12 => array:2 [ "nombre" => "A." "apellidos" => "González Quesada" ] 13 => array:2 [ "nombre" => "J.M." "apellidos" => "Carrascosa Carrillo" ] 14 => array:2 [ "nombre" => "M." "apellidos" => "Llamas-Velasco" ] 15 => array:2 [ "nombre" => "M.V." "apellidos" => "Mendiola Fernández" ] 16 => array:2 [ "nombre" => "D." "apellidos" => "Ruiz Genao" ] 17 => array:2 [ "nombre" => "C." "apellidos" => "Muñoz Santos" ] 18 => array:2 [ "nombre" => "I." "apellidos" => "García-Doval" ] 19 => array:2 [ "nombre" => "M.A." "apellidos" => "Descalzo" ] 20 => array:1 [ "colaborador" => "grupo de estudio de Biobadaderm" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S000173101830214X" "doi" => "10.1016/j.ad.2018.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101830214X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302269?idApp=UINPBA000044" "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302269/v1_201809020417/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "624" "paginaFinal" => "630" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Romero, D. de Argila, L. Ferrandiz, M.P. Sánchez, S. Vañó, R. Taberner, P. Pasquali, C. de la Torre, F. Alfageme, J. Malvehy, D. Moreno-Ramírez" "autores" => array:11 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Romero" "email" => array:1 [ 0 => "gromeroa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "D." "apellidos" => "de Argila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Ferrandiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.P." "apellidos" => "Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Vañó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Taberner" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "P." "apellidos" => "Pasquali" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 7 => array:3 [ "nombre" => "C." "apellidos" => "de la Torre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 8 => array:3 [ "nombre" => "F." "apellidos" => "Alfageme" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 9 => array:3 [ "nombre" => "J." "apellidos" => "Malvehy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "i" "identificador" => "aff0045" ] ] ] 10 => array:3 [ "nombre" => "D." "apellidos" => "Moreno-Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen Macarena, Seville, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Unidad de Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, Balearic Islands, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Pius, Valls, Tarragona, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Puerta de Hierro, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Servicio de Dermatología, Unidad de Melanoma, Hospital Clínic, Barcelona, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelos de práctica de la teledermatología en España. Estudio longitudinal 2009-2014" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1751 "Ancho" => 2385 "Tamanyo" => 284041 ] ] "descripcion" => array:1 [ "en" => "Spanish centers that use teledermatology by autonomous community, 2009 vs 2014 (25 in 2009; 70 in 2014)." ] ] ] "textoCompleto" => "IntroductionTeledermatology (TD)—the practice of dermatology by means of communication technologies—is considered to be the most advanced clinical specialty in telemedicine.<a class="elsevierStyleCrossRefs" href="#bib0135">1,2</a> Store-and-forward TD, based solely on still photography, is becoming more common at the expense of real-time TD, which involves videoconferencing.<a class="elsevierStyleCrossRef" href="#bib0145">3</a> TD is also the most widely studied telemedicine specialty.<a class="elsevierStyleCrossRefs" href="#bib0150">4,5</a> Despite the growing popularity of the practice, it is not clear whether TD should be considered a mature application,<a class="elsevierStyleCrossRefs" href="#bib0160">6,7</a> especially with regard to health outcomes in clinical practice. In fact, TD has been widely debated in some countries where the practice has a long tradition, including the United Kingdom<a class="elsevierStyleCrossRef" href="#bib0170">8</a> and Spain.<a class="elsevierStyleCrossRef" href="#bib0150">4</a> The large-scale utility of TD as a diagnostic instrument has been demonstrated in the Netherlands.<a class="elsevierStyleCrossRef" href="#bib0175">9</a> Despite the apparently incremental increase in the use of this approach around the world, there have been very few studies on the implementation and characterization of TD modalities in developed countries. The exception is an interesting study from 2012 on the practice models and real-world challenges associated with TD in California, which provides an in-depth analysis of TD practice in the state.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> The following year saw the publication of a longitudinal study that assessed the development of TD programs in the United States (US) between 2003 and 2011.<a class="elsevierStyleCrossRef" href="#bib0185">11</a>Given the scarcity of research on this subject, it can be difficult for dermatologists to obtain relevant information about practice models and the potential challenges associated with TD. Moreover, we believe it is important to understand the development of this technology outside of the United States, particularly in Spain—hence our motivation for the present study. The main objectives of this study were to analyze the extent of TD implementation in Spain and describe the most important characteristics of the practice, including organization, population served, technology, research, training, advantages, and disadvantages. We present the results of a comparative longitudinal study consisting of 2surveys, carried out in 2009 and 2014 by the Imaging Group of the Spanish Academy of Dermatology and Venereology (AEDV).MethodsThe study was approved by the research committee at Hospital General Universitario de Ciudad Real. For the first survey, carried out in 2009, all AEDV members were contacted by email with the aim of identifying dermatologists who practiced TD. For the second survey, carried out in 2014 with the collaboration of AbbVie's Spanish sales network, the heads of all dermatology departments in Spain (n=267) were contacted in person and asked about TD use in their departments. The teledermatologists identified by both methods were asked to identify other teledermatologists who may not have been contacted.Once the centers that used TD had been identified, they were sent a full survey by email in order to obtain an accurate description of each center's functional model. The authors developed the survey questions in collaboration with the Imaging Group's committee members. The questions focused on 5 areas: (a) characteristics and organization of the center; (b) operational considerations; (c) technical data; (d) objectives of TD at the center; and (e) challenges associated with TD use (advantages and disadvantages). The 2014 questionnaire was somewhat longer as it included more items than the 2009 version; as a consequence, certain comparisons were not possible.ResultsA. Characteristics of centers that used TD: In 2009, after all AEDV members were contacted by email, we identified 25 centers that used TD, 21 of which (84%) completed an exhaustive survey. In 2014, all dermatology departments in Spain (n=267) were contacted in person. Of the 267 centers, 70 (26.2%) used TD (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); however, only 42 centers (60%) completed the survey. In 2014, experience with TD ranged from 0.3 to 17 years; mean experience was 4.9 years. Consistent with the findings of the 2009 survey, in 2014 there were 24 centers with less than 4 years of experience and 17 with more than 5 years of experience. Only 5 centers had more than 10 years of experience. All centers that used TD belonged to the Spanish national health system and most were university hospitals (57%). Many teams had 5 or more dermatologists on staff (33% had 5-8 dermatologists; 24% had 9-15 dermatologists). Local hospitals with fewer than 4 dermatologists on staff accounted for 43% of the centers that used TD. On each team, telemedicine consultations were generally handled by a group of just 1 to 3 dermatologists. In 2009, just 15% of the centers spent more than 5hours per week on TD; by 2014, this figure had nearly doubled, to 29%. In 2014, 12 of 41 centers (29%) saw a large volume of patients by TD (more than 100 patients per month), while 8 centers (19%) saw fewer than 20 patients per month.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>B. Health care organization and TD models: The number of centers with specific hours reserved for TD appointments increased from 8 of 21 centers surveyed (38%) in 2009 to 22 of 41 centers (53%) in 2014. In 2014, 24 of 32 centers (75%) used TD to treat patients who lived less than 25km away, while just 4 of 37 centers (11%) used TD to see patients who lived more than 100km away. The percentage of centers treating patients more than 100km away was nearly 4 times higher in 2009, when 8 of 21 centers (39%) reported this practice. These findings reveal a clear trend towards a more urban use of TD (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In Spain, 79% of teledermatologists and 75% of primary care physicians who practice TD do so without a nurse or other support staff. Such support is more common in real-time TD models. The store-and-forward TD model was used by 14 of 21 centers in 2009 (67%); this figure increased to 34 of 41 centers (83%) in 2014. In contrast, the use of real-time TD decreased from 24% in 2009 to 12% in 2014, while the use of hybrid systems fell from 9% to 5% over the same period (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In 2014, most centers used mid-range bridge cameras, 15% used teledermoscopy, and only 12% used mobile devices.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>C. Technical aspects: Regarding software, at 60% of centers the dermatologists participated in the development of the software and data collection system. Obligatory elements were included in 70% of the information systems used for TD. At 66% of the centers, it was possible to export data for use outside the system. In contrast to the level of development observed in the data-management software used in TD, just 33% of centers used diagnostic coding in 2014. Only 19% of centers had integrated their TD system with the hospital information system and appointment system in 2009, but by 2014 this figure had risen to 64%. This large increase reflects the notable development of electronic health records in recent years. In 2014, the mean satisfaction with the computer system reported by dermatologists was 7.15 on a scale of 0 to 10.D. Objectives of TD: In 2014, a majority of the centers (62%) used TD in the treatment of all types of skin conditions, while 25% used it only for skin cancer (down from 38% in 2009). In 2014, 40% of the centers were able to schedule surgical appointments directly, with no need for a presurgical clinical appointment. (The survey did not ask about this option in 2009.) Two thirds of the centers used TD in the training of primary care physicians. Training took place by teleconsultation at 33% of centers, in seminars and meetings in 17% of centers, and by both methods in 31% of centers. Sixty-six percent of the centers used TD for teaching in 2014 and a similar percentage was reported in 2009. In contrast, just 20% of the centers carried out patient satisfaction surveys.E. Advantages and disadvantages (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>): On a scale of 0 to 10, mean overall satisfaction with TD increased from 6.3 points in 2009 to 6.9 points in 2014. The main advantages and disadvantages of TD perceived by dermatologists were similar in 2009 and 2014. Among the main advantages were patient prioritization and communication with family doctors; in both surveys, poor photo quality was the main disadvantage reported. Internet connection speed was a problem for some centers in 2009, but not in 2014. The dermatologists assessed the various advantages and disadvantages on a scale of 0 to 10 in 2014; the results are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>As for overall trends, between 2009 and 2014 there was an increase in the number of centers using TD, the number of teledermatologists per center, the time spent on TD, the quality of technology and organization, the number of centers using store-and-forward TD systems, and the use of TD in urban settings (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).DiscussionThis study attempted to characterize the Spanish health care facilities that used TD in 2014 and to analyze changes and trends since 2009. Our findings show that TD is an emerging technology in Spain (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Between 2009 and 2014, the number of centers using TD in Spain practically tripled. Moreover, each center had more teledermatologists on staff, spent more time on TD, was better organized, and had better technology in 2014 than in 2009. There was also an incremental increase in the use of store-and-forward TD at the expense of real-time TD systems, as well as a trend towards more urban use of TD (in order words, the use of TD with patients who live closer the hospital).Our study had some methodological limitations. The use of online surveys as a study method limited the response rate and left open the possibility of inaccurate responses. The initial methods of contacting the dermatologists were different in 2009 and 2014, so it is possible that undetected differences might exist. Some departments that actively use TD did not respond to the survey; this could be considered selection bias. Exhaustivity of access was the main advantage of our study, especially in 2014, when in-person access to 267 centers was achieved. Other strengths were the wealth and variety of the topics studied, as well as the high response rate among centers that use TD, both in 2009 and in 2014. These strengths suggest that the data obtained are representative and reliable.Two longitudinal studies have analyzed the evolution of TD use in the United States.<a class="elsevierStyleCrossRefs" href="#bib0185">11,12</a> These studies found similar trends to those identified in Spain: an increase in TD use overall and in the use of store-and-forward models in particular. Although the number of TD programs in the United States fell from 62 in 2003 to 37 in 2011, the annual volume of consultations per center increased significantly, nearly doubling.<a class="elsevierStyleCrossRef" href="#bib0185">11</a> Thus, one of the largest TD programs in the United States—that of the Veterans Health Administration (VHA)<a class="elsevierStyleCrossRef" href="#bib0190">12</a>—showed rapid growth in the number of TD consultations in recent years. As in Spain, TD in the United States has been shifting away from real-time methods (videoconference technology) since 2007, in favor of modalities involving the storage of still photographs.<a class="elsevierStyleCrossRefs" href="#bib0185">11,12</a> Nowadays, store-and-forward is the predominant TD technology, probably because of its low cost, higher image quality, and the fact that an asynchronous approach allows for better organization and greater efficiency.Only 1 transversal study has offered a comprehensive, in-depth analysis of TD models over a large geographical area. In this study, Armstrong et al.<a class="elsevierStyleCrossRef" href="#bib0180">10</a> studied TD in California—the most populous US state, with 38 million inhabitants—between 2007 and 2011. The authors identified just 17 teledermatologists working actively in 2011—a figure that stands in stark contrast to the 105 teledermatologists identified in 2014 in Spain, which has a population (46 million inhabitants) similar to that of California. The number of teledermatologists per million inhabitants was clearly lower in California (.44) than in Spain (2.28). In California, as in our study, the predominant TD model was store-and-forward (70%); however, hybrid systems were used by a larger percentage of teledermatologists in California (18%). As in Spain, the percentage of teledermatologists using only real-time TD was very low (6%). Mean experience with TD was similar in California and Spain (3.85 and 4.9 years, respectively). However, the objectives of TD use were different in Spain and California. In California, 75% of patients seen by TD had a low socioeconomic status and lived in remote rural areas. In contrast, most centers that used TD in Spain were concentrated in large cities (Seville, Madrid, and Barcelona) and this technology was used to see all types of patients. In their discussion section, Armstrong et al. describe TD as a rapidly evolving field but note that this technique should logically always serve as a complement to face-to-face options. The authors predict that future TD use will not be limited to rural communities or citizens at risk of exclusion. We agree with this view and our results support this theory; in Spain, the urban focus of TD is already a reality,<a class="elsevierStyleCrossRef" href="#bib0195">13</a> as is the rapid development of TD in heavily populated areas of Europe such as the Netherlands and the United Kingdom. It is possible that the use of TD in the United States will begin to catch up with the European model. In fact, in the VHA program, patients seen by TD in urban areas have outnumbered patients in rural areas since 2012.<a class="elsevierStyleCrossRef" href="#bib0190">12</a>The advantages described by Californian teledermatologists are similar to those reported by Spanish teledermatologists: greater efficiency, access, speed of care, and patient satisfaction. The main disadvantages were somewhat different; Californian dermatologists reported problems with reimbursement for teleconsultations as well as costly and inefficient software. In other areas, however, Californian and Spanish dermatologists voiced similar concerns. In both places, image quality and complex skin conditions were the main factors that limited the ability of TD to prevent face-to-face consultations. Moreover, on both sides of the Atlantic, dermatologists agreed that store-and-forward TD should not replace face-to-face consultations entirely. The option of face-to-face consultations should always exist, and for some conditions—for example, a patient with multiple pigmented lesions—face-to-face consultation is the only option and assessment by TD is contraindicated.<a class="elsevierStyleCrossRefs" href="#bib0145">3,8,13</a> Technological and legal considerations are also important barriers but can probably be overcome in the near future. According to the sample surveyed in our study, this trend towards future technological improvements appears to be evident. Potential improvements in the area of legal issues were not measured in the survey.Despite these and other challenges in telemedicine, the development of TD appears to be unstoppable. In 2010, 38% of countries had some sort of TD program and 30% had governmental agencies dedicated to this practice.<a class="elsevierStyleCrossRef" href="#bib0135">1</a> Multiple studies have provided evidence to support the reliability (agreement between diagnosis and management) and accuracy (validity compared to a gold standard) of TD.<a class="elsevierStyleCrossRef" href="#bib0200">14</a> Store-and-forward TD has been shown to be effective in reducing the number of face-to-face consultations in hospitals.<a class="elsevierStyleCrossRef" href="#bib0205">15</a> Face-to-face consultations and store-and-forward TD have shown similar results in terms of clinical improvement and time to intervention in patients with skin cancer.<a class="elsevierStyleCrossRefs" href="#bib0145">3,16</a> In recent years, there has been a considerable increase in the number of successful TD programs for managing skin cancer<a class="elsevierStyleCrossRef" href="#bib0195">13</a> and for providing a rapid response in large urban areas.<a class="elsevierStyleCrossRef" href="#bib0175">9</a> Patients have reported high satisfaction and a willingness to pay out of pocket to access TD services.<a class="elsevierStyleCrossRef" href="#bib0215">17</a> TD has been shown to be cost-effective when used as a triage mechanism to reduce appointments and travel<a class="elsevierStyleCrossRef" href="#bib0220">18</a> and to reduce the time to the initial intervention. TD is currently seen as a solution for many deficiencies in health systems.<a class="elsevierStyleCrossRefs" href="#bib0225">19–21</a> The technique can be used to increase accessibility for patients who live in remote areas or in geriatric facilities, prioritize cancer diagnosis, prevent referrals for trivial disease, and accelerate care in cases of emergency, among other benefits. The opinions of the Spanish dermatologists (n=42) who use and understand TD support these views (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Assessed on a scale of 0 to 10, the median score for advantages such as improved communication with primary care physicians, screening for trivial conditions, reduction in the number of face-to-face visits, and prioritization of conditions requiring urgent care and cancers was higher than 8. The main problems or disadvantages, also assessed on a scale of 0 to 10 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), received clearly lower scores (median score=4), with the exception of risk of error and poor photo quality (median score=6). Indeed, the reliability of TD is the parameter that has been most widely studied.<a class="elsevierStyleCrossRef" href="#bib0200">14</a> The reliability of TD has been shown to be comparable to that of face-to-face consultation for diagnosis and management, although logically the photographs must be of sufficient quality in order for TD to achieve this reliability in diagnosis and management.In our view, the main achievement of TD in Spain has been to improve the quality of health care processes, and this fact explains the considerable development of TD that has taken place in Spain.<a class="elsevierStyleCrossRef" href="#bib0150">4</a> TD use has also increased in other developed countries, such as the United States and European countries.<a class="elsevierStyleCrossRefs" href="#bib0240">22–25</a> In the United States, TD use increased from 7% to 11% between 2012 and 2014.<a class="elsevierStyleCrossRef" href="#bib0250">24</a> In the Netherlands, TD is fully reimbursed and integrated in the national health system.<a class="elsevierStyleCrossRef" href="#bib0240">22</a> The use of TD is also on the rise in the United Kingdom, where resistance to this technique among dermatologists is decreasing.<a class="elsevierStyleCrossRef" href="#bib0255">25</a> Developing countries, meanwhile, are probably just beginning to apply this technique. A recent study in South Africa found no evidence of the scaling of TD services or of the integration of TD into routine health care.<a class="elsevierStyleCrossRef" href="#bib0260">26</a>Our study showed that the development of TD in Spain is considerable but that there is still much room for improvement, and that it is important not only to increase the number of TD programs but also to improve their quality. Health care providers must give dermatologists sufficient time for teleconsultations and adequate resources (software integrated with diagnostic coding, quality cameras and dermoscopes).In conclusion, TD is an emerging technology that is becoming well established in Spain. In 2014, more than 25% of public dermatology centers in Spain had introduced a TD system. The levels of development and implementation of TD appear to be higher in Spain than in countries on the cutting edge of telemedicine such as the United States. The predominant model in Spain—store-and-forward TD in urban settings—is similar to that of the Netherlands, and the United States appears to be adopting this trend. In line with findings in other countries, Spanish dermatologists perceive TD as an effective option with more advantages than disadvantages. Dermatologists are generally highly satisfied with TD, although there are still areas in need of significant improvement.Conflicts of InterestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1077281" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1023309" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1077282" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1023308" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of Interest" ] 9 => array:2 [ "identificador" => "xack364960" "titulo" => "Acknowledgments" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-14" "fechaAceptado" => "2018-03-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1023309" "palabras" => array:4 [ 0 => "Telemedicine" 1 => "Teledermatology" 2 => "Teleconsultation" 3 => "Health service research" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1023308" "palabras" => array:4 [ 0 => "Telemedicina" 1 => "Teledermatología" 2 => "Teleconsulta" 3 => "Investigación en servicios de salud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionTeledermatology is the most advanced clinical specialty in telemedicine. The development of teledermatology in specific countries has not been studied in depth. MethodsOur objective was to analyze teledermatology models in clinical practice in Spain. We paid special attention to organization, technical aspects, training, and the advantages/disadvantages as seen by teledermatologists. Two surveys were carried out (2009 and 2014). ResultsTeledermatology was used at 25 centers in 2009 and at 70 in 2014. The extended survey was completed by 21 centers in 2009 and 41 in 2014. Store-and-forward teledermatology was the main technique (83%) in 2014. Only 12% of centers used the real-time method, and 5% used a hybrid modality. Patients lived less than 25km away in 75% of cases (urban teledermatology). Most centers used mid-range bridge cameras; only 12% used mobile phones. Teledermoscopy and tertiary teledermatology were each used in 15% of centers. Teledermatology was restricted to skin cancer in 25% of cases, and 66% of centers used it to train primary care physicians. The main advantages, assessed on a scale of 1 to 10, were prioritization in cancer screening (8.3), rapid emergency care (7.8), training of and communication with primary care physicians (7.6), screening for trivial conditions (7.6), and reduction in the number of face-to-face visits (7.6). The main disadvantages were poor image quality (6.3), fear of error (5.7), difficulty in coordinating with primary care physicians (3.8), and time commitment (3.3). Between 2009 and 2014, the number of centers using teledermatology and the number of teledermatologists increased, as did use of the store-and-forward and urban models. The technology used also improved. ConclusionTeledermatology is an emerging technology that is becoming well established in Spain. More than 25% of dermatology centers in Spain have implemented a teledermatology model. Store-and-forward in an urban setting is the most widely used modality. Teledermatologists see this technology as an effective option with more advantages than disadvantages. General satisfaction is high, although there is room for significant improvement in some areas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa teledermatología (TD) es la especialidad clínica más desarrollada de la telemedicina. El desarrollo de la TD en un país completo no se ha estudiado previamente en profundidad. MétodosEl objetivo fue analizar los modelos de TD en práctica real en España, centrándose en la organización, los aspectos técnicos, la docencia y las ventajas/desventajas percibidas por los teledermatólogos. Se realizaron 2encuestas con teledermatólogos en 2009 y 2014. ResultadosSe identificaron 25 centros utilizando TD en 2009 y 70 en 2014. La encuesta ampliada fue completada por 21 centros en 2009 y 42 en 2014. Las características generales en 2014 fueron: TD almacenamiento (TDA) fue la técnica predominante (83%), solo el 12% TD en tiempo real y el 5% TD híbrida. El 75% de los pacientes vistos en TD viven a menos de 25 km (TD urbana). La mayoría de los centros utilizan cámaras bridge de gama media y solo el 12% utiliza los teléfonos móviles. El 15% practica teledermoscopia y el 15% TD terciaria. En el 25%, la TD se restringió a la oncología cutánea; el 66% utiliza la TD para formación de médicos de primaria. Las ventajas principales (puntuación 0-10) fueron priorización en oncología (8,3), asistencia rápida de urgencias (7,8), la formación y la comunicación con los médicos de primaria (7,6), el cribado de enfermedad banal (7,6) y la disminución de las visitas presenciales (7,6). Los principales inconvenientes fueron (puntuación 0-10): la baja calidad de imágenes (6,3), el miedo al error (5,7), difícil coordinación con los médicos de primaria (MP) (3,8) y consumo de tiempo (3,3). La evolución 2009-2014 mostró más centros con TD y más teledermatólogos, mejor tecnología y aumento de los modelos TDA y urbano. ConclusiónLa TD es una tecnología emergente que comienza su fase de consolidación en España. Más del 25% de los centros de dermatología en España han puesto en práctica un sistema de TD. El modelo predominante es TDA en un entorno urbano. Los dermatólogos perciben la TD como una opción efectiva con más ventajas que desventajas. La satisfacción general es alta, sin embargo, todavía hay áreas que necesitan mejoras significativas." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Romero G, de Argila D, Ferrandiz L, Sánchez MP, Vañó S, Taberner R, et al. Modelos de práctica de la teledermatología en España. Estudio longitudinal 2009-2014. Actas Dermosifiliogr. 2018;109:624–630." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1751 "Ancho" => 2385 "Tamanyo" => 284041 ] ] "descripcion" => array:1 [ "en" => "Spanish centers that use teledermatology by autonomous community, 2009 vs 2014 (25 in 2009; 70 in 2014)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 877 "Ancho" => 1441 "Tamanyo" => 68174 ] ] "descripcion" => array:1 [ "en" => "Models of teledermatology in Spain, 2009 vs 2014. Abbreviations: S&FTD, store-and-forward teledermatology (still photography); RTTD, real-time teledermatology (videoconference)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 978 "Ancho" => 2586 "Tamanyo" => 150635 ] ] "descripcion" => array:1 [ "en" => "Advantages and disadvantages of using a TD system in 2014 (dermatologist's perspective on a scale of 0 to 10). The main advantages are scored on a scale of 0 (strongly disagree) to 10 (fully agree). The main disadvantages or problems are scored on a scale of 0 (nonexistent problem) to 10 (the problem is very serious and difficult to solve) (n = 42; ranges and medians). TD indicates teledermatology; PC, primary care." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall Comparison</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2009 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2014 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Centers using TD</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Departments that completed the survey</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Experience with TD (mean and range in years)</td><td class="td" title="table-entry " align="left" valign="top">3.1 (0.2-14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.9 (0.5-17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">TD modality</td><td class="td" title="table-entry " align="left" valign="top">Store-and-forward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67% (14/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83% (35/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Real-time \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23% (5/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12% (5/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decrease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hybrid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9% (2/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.5% (2/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decrease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Skin diseases assessed by TD</td><td class="td" title="table-entry " align="left" valign="top">All types \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62% (13/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81% (34/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer only \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33% (7/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16,6% (7/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decrease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.7% (1/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.4% (1/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Similar \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Hours per week spent on TD (mean and range)</td><td class="td" title="table-entry " align="left" valign="top">3 (1-12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.67 (0.5-18) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Number of dermatologists practicing TD in each department (mean and range)</td><td class="td" title="table-entry " align="left" valign="top">2.3 (1-6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.8 (1-7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="top">Greatest distance between center and TD patient</td><td class="td" title="table-entry " align="left" valign="top">Less than 50 km \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28% (6/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">46% (17/37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Between 50 and 100 km \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38% (8/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43% (16/37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">More than 100 km \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33% (7/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11% (4/37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Decrease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">TD software integrated into hospital information system</td><td class="td" title="table-entry " align="left" valign="top">33% (7/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66% (28/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increase \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Training objectives for primary care physicians (e-learning)</td><td class="td" title="table-entry " align="left" valign="top">61% (13/21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66% (28/42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Similar \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1838874.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparison of 2009 and 2014 Survey Findings." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "WHO. Telemedicine: Opportunities and developments in member states. Geneva, Switzerland: World Health Organization; 2010. p. 1-96." ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Telemedicine and teledermatology (I): Concepts and applications]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Romero" 1 => "J.A. Garrido" 2 => "M. Garcia-Arpa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "506" "paginaFinal" => "522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18682163" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0039606015003219" "estado" => "S300" "issn" => "00396060" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology: From historical perspective to emerging techniques of the modern era: Part I: History, rationale, and current practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.J. Coates" 1 => "J. Kvedar" 2 => "R.D. Granstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.07.061" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2015" "volumen" => "72" "paginaInicial" => "563" "paginaFinal" => "574" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25773407" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology: From the tempest of debate to calmer waters" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Moreno-Ramirez" 1 => "G. Romero-Aguilera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2016.01.006" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2016" "volumen" => "107" "paginaInicial" => "366" "paginaFinal" => "368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26956401" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Hersh WR, Hickam DH, Severance DS. Telemedicine for the Medicare Population: Update. In: Agency for Healthcare Research and Quality, editor. AHRQ Publication No. 06-E007. 2006." ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Totten AM, Omack DM, Eden KB, McDonagh AJ, Griffin JC, Grusing S, et al. Telehealth: Mapping the evidence for patient outcomes from systematic reviews. AHRQ Publication No.16-EHC034-EF. 2016." ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maturity of teledermatology evaluation research: A systematic literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Eminovic" 1 => "N.F. de Keizer" 2 => "P.J. Bindels" 3 => "A. Hasman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2006.07627.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "156" "paginaInicial" => "412" "paginaFinal" => "419" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17300227" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Has teledermatology in the U.K. finally failed?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.S. English" 1 => "D.J. Eedy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2007.07750.x" "Revista" => array:5 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2007" "volumen" => "156" "paginaInicial" => "411" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17300226" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.P. Van der Heijden" 1 => "N.F. de Keizer" 2 => "J.D. Bos" 3 => "P.I. Spuls" 4 => "L. Witkamp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2011.10509.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2011" "volumen" => "165" "paginaInicial" => "1058" "paginaFinal" => "1065" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21729026" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice models and challenges in teledermatology: A study of collective experiences from teledermatologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.W. Armstrong" 1 => "M.W. Kwong" 2 => "L. Ledo" 3 => "T.S. Nesbitt" 4 => "S.L. Shewry" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0028687" "Revista" => array:6 [ "tituloSerie" => "PLoS One" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "e28687" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22194887" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0039606015008168" "estado" => "S300" "issn" => "00396060" ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "State of teledermatology programs in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.W. Armstrong" 1 => "J. Wu" 2 => "C.L. Kovarik" 3 => "M.E. Goldyne" 4 => "D.H. Oh" 5 => "K.C. McKoy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2012.02.019" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2012" "volumen" => "67" "paginaInicial" => "939" "paginaFinal" => "944" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459360" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology within the Veterans Health Administration, 2002-2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.M. Landow" 1 => "D.H. Oh" 2 => "M.A. Weinstock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/tmj.2014.0225" "Revista" => array:6 [ "tituloSerie" => "Telemed J E Health" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "769" "paginaFinal" => "773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26083585" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 10-year history of teledermatology for skin cancer management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Moreno-Ramirez" 1 => "L. Ferrandiz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2015" "volumen" => "14" "paginaInicial" => "1" "paginaFinal" => "2" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "[Telemedicine and teledermatology (II): Current state of research on dermatology teleconsultations]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Romero" 1 => "P. Cortina" 2 => "E. Vera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2008" "volumen" => "99" "paginaInicial" => "586" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19080890" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: Proposal for quantitative synthesis in a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Wootton" 1 => "K. Bahaadinbeigy" 2 => "D. Hailey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6963-11-185.:185-11" "Revista" => array:5 [ "tituloSerie" => "BMC Health Serv Res" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21824388" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: A cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Moreno-Ramirez" 1 => "T. Ojeda-Vila" 2 => "J.J. Rios-Martin" 3 => "R. Ruiz-Villaverde" 4 => "M. de-Troya" 5 => "A. Sanz-Trelles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2014.04.049" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2014" "volumen" => "71" "paginaInicial" => "507" "paginaFinal" => "515" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24894454" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0039606015006364" "estado" => "S300" "issn" => "00396060" ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology for the diagnosis and management of skin cancer: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Finnane" 1 => "K. Dallest" 2 => "M. Janda" 3 => "H.P. Soyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2016" "volumen" => "7" "paginaInicial" => "10" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of store-and-forward teledermatology: A systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Snoswell" 1 => "A. Finnane" 2 => "M. Janda" 3 => "H.P. Soyer" 4 => "J.A. Whitty" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2016.0525" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2016" "volumen" => "152" "paginaInicial" => "702" "paginaFinal" => "708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27074289" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Teledermatology is the answer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.J. Motley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.e6593" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2012" "volumen" => "345" "paginaInicial" => "e6593" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23033424" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The teledermatology train is coming: Get on board, get out of the way, or get run over" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.E. Burdick" 1 => "S.C. Simmons" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Cutis" "fecha" => "2011" "volumen" => "88" "paginaInicial" => "213" "paginaFinal" => "214" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22272479" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0039606015008946" "estado" => "S300" "issn" => "00396060" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Teledermatology: Diagnosis, triage and effective care of dermatology. NHS Bristol 2012 November 5 [cited 2015 Dec 5]. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.evidence.nhs.uk/qipp">http://www.evidence.nhs.uk/qipp</a>" ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Two decades of teledermatology: Current status and integration in national healthcare systems" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Tensen" 1 => "J.P. van der Heijden" 2 => "M.W. Jaspers" 3 => "L. Witkamp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13671-016-0136-7" "Revista" => array:6 [ "tituloSerie" => "Curr Dermatol Rep" "fecha" => "2016" "volumen" => "5" "paginaInicial" => "96" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182461" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of teledermatology on access to dermatology care among Medicaid enrollees" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Uscher-Pines" 1 => "R. Malsberger" 2 => "L. Burgette" 3 => "A. Mulcahy" 4 => "A. Mehrotra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2016.0938" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2016" "volumen" => "152" "paginaInicial" => "905" "paginaFinal" => "912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27144986" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in dermatology practices and the implications for the workforce" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ehrlich" 1 => "J. Kostecki" 2 => "H. Olkaba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2017.06.030" "Revista" => array:7 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "2017" "volumen" => "77" "paginaInicial" => "746" "paginaFinal" => "752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28784330" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673603147460" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing use and attitudes towards teledermatology in the UK over 10 years: Results of the 2016 National Survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.H. Mehrtens" 1 => "S.M. Halpern" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "10" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A review and critique of teledermatology in the South African Public Health Sector" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L.E. Walters" 1 => "M. Mars" 2 => "R.E. Scott" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Stud Health Technol Inform" "fecha" => "2016" "volumen" => "231" "paginaInicial" => "143" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27782026" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack364960" "titulo" => "Acknowledgments" "texto" => "We are grateful to the AbbVie sales network for collaborating on the distribution and collection of the surveys in 2014." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302245/v1_201809020417/en/main.assets" "Apartado" => array:4 [ "identificador" => "6155" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000007/v1_201809020417/S1578219018302245/v1_201809020417/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302245?idApp=UINPBA000044"]

Statistics

ORIGINAL

Practice Models in Teledermatology in Spain: Longitudinal Study, 2009-2014

Modelos de práctica de la teledermatología en España. Estudio longitudinal 2009-2014

G. Romeroa,

Corresponding author

gromeroa@gmail.com

Corresponding author.

, D. de Argilab, L. Ferrandizc, M.P. Sáncheza, S. Vañód, R. Tabernere, P. Pasqualif, C. de la Torreg, F. Alfagemeh, J. Malvehyi, D. Moreno-Ramírezc

a Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

b Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, Spain

c Servicio de Dermatología, Hospital Universitario Virgen Macarena, Seville, Spain

d Servicio de Dermatología, Hospital Universitario Unidad de Ramón y Cajal, Madrid, Spain

e Servicio de Dermatología, Hospital Son Llàtzer, Palma de Mallorca, Balearic Islands, Spain

f Servicio de Dermatología, Hospital Pius, Valls, Tarragona, Spain

g Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain

h Servicio de Dermatología, Hospital Puerta de Hierro, Madrid, Spain

i Servicio de Dermatología, Unidad de Melanoma, Hospital Clínic, Barcelona, Spain

Read

5413

Times
was read the article

2284

Total PDF

3129

Total HTML

Share statistics

 array:24 [
  "pii" => "S1578219018302245"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2018.06.013"
  "estado" => "S300"
  "fechaPublicacion" => "2018-09-01"
  "aid" => "1957"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Actas Dermosifiliogr. 2018;109:624-30"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 127
    "formatos" => array:2 [
      "HTML" => 119
      "PDF" => 8
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0001731018301820"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2018.03.015"
      "estado" => "S300"
      "fechaPublicacion" => "2018-09-01"
      "aid" => "1957"
      "copyright" => "AEDV"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Actas Dermosifiliogr. 2018;109:624-30"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 431
        "formatos" => array:2 [
          "HTML" => 243
          "PDF" => 188
        ]
      ]
      "es" => array:14 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Modelos de pr&#225;ctica de la teledermatolog&#237;a en Espa&#241;a&#46; Estudio longitudinal 2009-2014"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:3 [
          0 => "es"
          1 => "es"
          2 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "624"
            "paginaFinal" => "630"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Practice Models in Teledermatology in Spain&#58; Longitudinal Study&#44; 2009-2014"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 1
          "multimedia" => array:5 [
            "identificador" => "fig0020"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => false
            "mostrarDisplay" => true
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "fx1.jpeg"
                "Alto" => 937
                "Ancho" => 1333
                "Tamanyo" => 90419
              ]
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "G&#46; Romero, D&#46; de Argila, L&#46; Ferrandiz, M&#46;P&#46; S&#225;nchez, S&#46; Va&#241;&#243;, R&#46; Taberner, P&#46; Pasquali, C&#46; de la Torre, F&#46; Alfageme, J&#46; Malvehy, D&#46; Moreno-Ram&#237;rez"
            "autores" => array:11 [
              0 => array:2 [
                "nombre" => "G&#46;"
                "apellidos" => "Romero"
              ]
              1 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "de Argila"
              ]
              2 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Ferrandiz"
              ]
              3 => array:2 [
                "nombre" => "M&#46;P&#46;"
                "apellidos" => "S&#225;nchez"
              ]
              4 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Va&#241;&#243;"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Taberner"
              ]
              6 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Pasquali"
              ]
              7 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "de la Torre"
              ]
              8 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Alfageme"
              ]
              9 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Malvehy"
              ]
              10 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "Moreno-Ram&#237;rez"
              ]
            ]
          ]
        ]
        "resumen" => array:1 [
          0 => array:3 [
            "titulo" => "Graphical abstract"
            "clase" => "graphical"
            "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><elsevierMultimedia ident="fig0020"></elsevierMultimedia></p></span>"
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1578219018302245"
          "doi" => "10.1016/j.adengl.2018.06.013"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302245?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018301820?idApp=UINPBA000044"
      "url" => "/00017310/0000010900000007/v1_201809020415/S0001731018301820/v1_201809020415/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1578219018302336"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2018.06.021"
    "estado" => "S300"
    "fechaPublicacion" => "2018-09-01"
    "aid" => "1950"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2018;109:631-42"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2
      "formatos" => array:2 [
        "HTML" => 1
        "PDF" => 1
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Management of Moderate to Severe Psoriasis in Routine Clinical Practice in Spanish Hospitals"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "631"
          "paginaFinal" => "642"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Manejo de la psoriasis moderada-grave en condiciones de pr&#225;ctica habitual en el &#225;mbito hospitalario espa&#241;ol"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0015"
          "etiqueta" => "Figure 3"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr3.jpeg"
              "Alto" => 1429
              "Ancho" => 2052
              "Tamanyo" => 193768
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Factors that lead the dermatologists to transition a patient from a traditional systemic treatment to a biologic and to limit the amount of time a patient stays on a traditional systemic therapy&#46; The reasons were ranked on a scale of 1 &#40;least important&#41; to 5 &#40;most important&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;L&#46; L&#243;pez-Estebaranz, P&#46; de la Cueva-Dobao, C&#46; de la Torre Fraga, M&#46; Gal&#225;n Guti&#233;rrez, E&#46; Gonz&#225;lez Guerra, J&#46; Mollet S&#225;nchez, I&#46; Belinch&#243;n Romero"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "L&#243;pez-Estebaranz"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "de la Cueva-Dobao"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "de la Torre Fraga"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Gal&#225;n Guti&#233;rrez"
            ]
            4 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Gonz&#225;lez Guerra"
            ]
            5 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Mollet S&#225;nchez"
            ]
            6 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Belinch&#243;n Romero"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0001731018301753"
        "doi" => "10.1016/j.ad.2018.02.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018301753?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302336?idApp=UINPBA000044"
    "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302336/v1_201809020417/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1578219018302269"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2018.06.015"
    "estado" => "S300"
    "fechaPublicacion" => "2018-09-01"
    "aid" => "1976"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Actas Dermosifiliogr. 2018;109:617-23"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 6
      "formatos" => array:2 [
        "HTML" => 2
        "PDF" => 4
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
      "titulo" => "Description of Patients Treated with Biologic Drugs as First-Line Systemic Therapy in the BIOBADADERM Registry Between 2008 and 2016"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "617"
          "paginaFinal" => "623"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Descripci&#243;n de los pacientes que reciben biol&#243;gicos como primer tratamiento sist&#233;mico en el registro BIOBADADERM durante el periodo 2008-2016"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3198
              "Ancho" => 1500
              "Tamanyo" => 203790
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Withdrawal from treatment&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "G&#46; Carretero Hern&#225;ndez, C&#46; Ferr&#225;ndiz, R&#46; Rivera D&#237;az, E&#46; Daud&#233;n Tello, P&#46; de la Cueva-Dobao, F&#46;J&#46; G&#243;mez-Garc&#237;a, E&#46; Herrera-Ceballos, I&#46; Belinch&#243;n Romero, J&#46;L&#46; L&#243;pez-Estebaranz, M&#46; Alsina Gibert, J&#46;L&#46; S&#225;nchez-Carazo, M&#46; Ferr&#225;n Farr&#233;s, A&#46; Gonz&#225;lez Quesada, J&#46;M&#46; Carrascosa Carrillo, M&#46; Llamas-Velasco, M&#46;V&#46; Mendiola Fern&#225;ndez, D&#46; Ruiz Genao, C&#46; Mu&#241;oz Santos, I&#46; Garc&#237;a-Doval, M&#46;A&#46; Descalzo"
          "autores" => array:21 [
            0 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Carretero Hern&#225;ndez"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Ferr&#225;ndiz"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Rivera D&#237;az"
            ]
            3 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Daud&#233;n Tello"
            ]
            4 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "de la Cueva-Dobao"
            ]
            5 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "G&#243;mez-Garc&#237;a"
            ]
            6 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Herrera-Ceballos"
            ]
            7 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Belinch&#243;n Romero"
            ]
            8 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "L&#243;pez-Estebaranz"
            ]
            9 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Alsina Gibert"
            ]
            10 => array:2 [
              "nombre" => "J&#46;L&#46;"
              "apellidos" => "S&#225;nchez-Carazo"
            ]
            11 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Ferr&#225;n Farr&#233;s"
            ]
            12 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Gonz&#225;lez Quesada"
            ]
            13 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Carrascosa Carrillo"
            ]
            14 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Llamas-Velasco"
            ]
            15 => array:2 [
              "nombre" => "M&#46;V&#46;"
              "apellidos" => "Mendiola Fern&#225;ndez"
            ]
            16 => array:2 [
              "nombre" => "D&#46;"
              "apellidos" => "Ruiz Genao"
            ]
            17 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Mu&#241;oz Santos"
            ]
            18 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Garc&#237;a-Doval"
            ]
            19 => array:2 [
              "nombre" => "M&#46;A&#46;"
              "apellidos" => "Descalzo"
            ]
            20 => array:1 [
              "colaborador" => "grupo de estudio de Biobadaderm"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S000173101830214X"
        "doi" => "10.1016/j.ad.2018.04.004"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S000173101830214X?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302269?idApp=UINPBA000044"
    "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302269/v1_201809020417/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
    "titulo" => "Practice Models in Teledermatology in Spain&#58; Longitudinal Study&#44; 2009-2014"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "624"
        "paginaFinal" => "630"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "G&#46; Romero, D&#46; de Argila, L&#46; Ferrandiz, M&#46;P&#46; S&#225;nchez, S&#46; Va&#241;&#243;, R&#46; Taberner, P&#46; Pasquali, C&#46; de la Torre, F&#46; Alfageme, J&#46; Malvehy, D&#46; Moreno-Ram&#237;rez"
        "autores" => array:11 [
          0 => array:4 [
            "nombre" => "G&#46;"
            "apellidos" => "Romero"
            "email" => array:1 [
              0 => "gromeroa&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "D&#46;"
            "apellidos" => "de Argila"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Ferrandiz"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;P&#46;"
            "apellidos" => "S&#225;nchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Va&#241;&#243;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Taberner"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Pasquali"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "de la Torre"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Alfageme"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Malvehy"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">i</span>"
                "identificador" => "aff0045"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "D&#46;"
            "apellidos" => "Moreno-Ram&#237;rez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:9 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital General Universitario de Ciudad Real&#44; Ciudad Real&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario de La Princesa&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Virgen Macarena&#44; Seville&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitario Unidad de Ram&#243;n y Cajal&#44; Madrid&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Son Ll&#224;tzer&#44; Palma de Mallorca&#44; Balearic Islands&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Pius&#44; Valls&#44; Tarragona&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Complejo Hospitalario Universitario de Pontevedra&#44; Pontevedra&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Puerta de Hierro&#44; Madrid&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
          8 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Unidad de Melanoma&#44; Hospital Cl&#237;nic&#44; Barcelona&#44; Spain"
            "etiqueta" => "i"
            "identificador" => "aff0045"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Modelos de pr&#225;ctica de la teledermatolog&#237;a en Espa&#241;a&#46; Estudio longitudinal 2009-2014"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1751
            "Ancho" => 2385
            "Tamanyo" => 284041
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Spanish centers that use teledermatology by autonomous community&#44; 2009 vs 2014 &#40;25 in 2009&#59; 70 in 2014&#41;&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Teledermatology &#40;TD&#41;&#8212;the practice of dermatology by means of communication technologies&#8212;is considered to be the most advanced clinical specialty in telemedicine&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1&#44;2</span></a> Store-and-forward TD&#44; based solely on still photography&#44; is becoming more common at the expense of real-time TD&#44; which involves videoconferencing&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> TD is also the most widely studied telemedicine specialty&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">4&#44;5</span></a> Despite the growing popularity of the practice&#44; it is not clear whether TD should be considered a mature application&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">6&#44;7</span></a> especially with regard to health outcomes in clinical practice&#46; In fact&#44; TD has been widely debated in some countries where the practice has a long tradition&#44; including the United Kingdom<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> and Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> The large-scale utility of TD as a diagnostic instrument has been demonstrated in the Netherlands&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> Despite the apparently incremental increase in the use of this approach around the world&#44; there have been very few studies on the implementation and characterization of TD modalities in developed countries&#46; The exception is an interesting study from 2012 on the practice models and real-world challenges associated with TD in California&#44; which provides an in-depth analysis of TD practice in the state&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> The following year saw the publication of a longitudinal study that assessed the development of TD programs in the United States &#40;US&#41; between 2003 and 2011&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given the scarcity of research on this subject&#44; it can be difficult for dermatologists to obtain relevant information about practice models and the potential challenges associated with TD&#46; Moreover&#44; we believe it is important to understand the development of this technology outside of the United States&#44; particularly in Spain&#8212;hence our motivation for the present study&#46; The main objectives of this study were to analyze the extent of TD implementation in Spain and describe the most important characteristics of the practice&#44; including organization&#44; population served&#44; technology&#44; research&#44; training&#44; advantages&#44; and disadvantages&#46; We present the results of a comparative longitudinal study consisting of 2<span class="elsevierStyleHsp" style=""></span>surveys&#44; carried out in 2009 and 2014 by the Imaging Group of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was approved by the research committee at Hospital General Universitario de Ciudad Real&#46; For the first survey&#44; carried out in 2009&#44; all AEDV members were contacted by email with the aim of identifying dermatologists who practiced TD&#46; For the second survey&#44; carried out in 2014 with the collaboration of AbbVie&#39;s Spanish sales network&#44; the heads of all dermatology departments in Spain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>267&#41; were contacted in person and asked about TD use in their departments&#46; The teledermatologists identified by both methods were asked to identify other teledermatologists who may not have been contacted&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Once the centers that used TD had been identified&#44; they were sent a full survey by email in order to obtain an accurate description of each center&#39;s functional model&#46; The authors developed the survey questions in collaboration with the Imaging Group&#39;s committee members&#46; The questions focused on 5 areas&#58; &#40;<span class="elsevierStyleItalic">a</span>&#41; characteristics and organization of the center&#59; &#40;<span class="elsevierStyleItalic">b</span>&#41; operational considerations&#59; &#40;<span class="elsevierStyleItalic">c</span>&#41; technical data&#59; &#40;<span class="elsevierStyleItalic">d</span>&#41; objectives of TD at the center&#59; and &#40;<span class="elsevierStyleItalic">e</span>&#41; challenges associated with TD use &#40;advantages and disadvantages&#41;&#46; The 2014 questionnaire was somewhat longer as it included more items than the 2009 version&#59; as a consequence&#44; certain comparisons were not possible&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A&#46; Characteristics of centers that used TD&#58;</span> In 2009&#44; after all AEDV members were contacted by email&#44; we identified 25 centers that used TD&#44; 21 of which &#40;84&#37;&#41; completed an exhaustive survey&#46; In 2014&#44; all dermatology departments in Spain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>267&#41; were contacted in person&#46; Of the 267 centers&#44; 70 &#40;26&#46;2&#37;&#41; used TD &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; however&#44; only 42 centers &#40;60&#37;&#41; completed the survey&#46; In 2014&#44; experience with TD ranged from 0&#46;3 to 17 years&#59; mean experience was 4&#46;9 years&#46; Consistent with the findings of the 2009 survey&#44; in 2014 there were 24 centers with less than 4 years of experience and 17 with more than 5 years of experience&#46; Only 5 centers had more than 10 years of experience&#46; All centers that used TD belonged to the Spanish national health system and most were university hospitals &#40;57&#37;&#41;&#46; Many teams had 5 or more dermatologists on staff &#40;33&#37; had 5-8 dermatologists&#59; 24&#37; had 9-15 dermatologists&#41;&#46; Local hospitals with fewer than 4 dermatologists on staff accounted for 43&#37; of the centers that used TD&#46; On each team&#44; telemedicine consultations were generally handled by a group of just 1 to 3 dermatologists&#46; In 2009&#44; just 15&#37; of the centers spent more than 5<span class="elsevierStyleHsp" style=""></span>hours per week on TD&#59; by 2014&#44; this figure had nearly doubled&#44; to 29&#37;&#46; In 2014&#44; 12 of 41 centers &#40;29&#37;&#41; saw a large volume of patients by TD &#40;more than 100 patients per month&#41;&#44; while 8 centers &#40;19&#37;&#41; saw fewer than 20 patients per month&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">B&#46; Health care organization and TD models&#58;</span> The number of centers with specific hours reserved for TD appointments increased from 8 of 21 centers surveyed &#40;38&#37;&#41; in 2009 to 22 of 41 centers &#40;53&#37;&#41; in 2014&#46; In 2014&#44; 24 of 32 centers &#40;75&#37;&#41; used TD to treat patients who lived less than 25<span class="elsevierStyleHsp" style=""></span>km away&#44; while just 4 of 37 centers &#40;11&#37;&#41; used TD to see patients who lived more than 100<span class="elsevierStyleHsp" style=""></span>km away&#46; The percentage of centers treating patients more than 100<span class="elsevierStyleHsp" style=""></span>km away was nearly 4 times higher in 2009&#44; when 8 of 21 centers &#40;39&#37;&#41; reported this practice&#46; These findings reveal a clear trend towards a more urban use of TD &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In Spain&#44; 79&#37; of teledermatologists and 75&#37; of primary care physicians who practice TD do so without a nurse or other support staff&#46; Such support is more common in real-time TD models&#46; The store-and-forward TD model was used by 14 of 21 centers in 2009 &#40;67&#37;&#41;&#59; this figure increased to 34 of 41 centers &#40;83&#37;&#41; in 2014&#46; In contrast&#44; the use of real-time TD decreased from 24&#37; in 2009 to 12&#37; in 2014&#44; while the use of hybrid systems fell from 9&#37; to 5&#37; over the same period &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; In 2014&#44; most centers used mid-range bridge cameras&#44; 15&#37; used teledermoscopy&#44; and only 12&#37; used mobile devices&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">C&#46; Technical aspects&#58;</span> Regarding software&#44; at 60&#37; of centers the dermatologists participated in the development of the software and data collection system&#46; Obligatory elements were included in 70&#37; of the information systems used for TD&#46; At 66&#37; of the centers&#44; it was possible to export data for use outside the system&#46; In contrast to the level of development observed in the data-management software used in TD&#44; just 33&#37; of centers used diagnostic coding in 2014&#46; Only 19&#37; of centers had integrated their TD system with the hospital information system and appointment system in 2009&#44; but by 2014 this figure had risen to 64&#37;&#46; This large increase reflects the notable development of electronic health records in recent years&#46; In 2014&#44; the mean satisfaction with the computer system reported by dermatologists was 7&#46;15 on a scale of 0 to 10&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">D&#46; Objectives of TD&#58;</span> In 2014&#44; a majority of the centers &#40;62&#37;&#41; used TD in the treatment of all types of skin conditions&#44; while 25&#37; used it only for skin cancer &#40;down from 38&#37; in 2009&#41;&#46; In 2014&#44; 40&#37; of the centers were able to schedule surgical appointments directly&#44; with no need for a presurgical clinical appointment&#46; &#40;The survey did not ask about this option in 2009&#46;&#41; Two thirds of the centers used TD in the training of primary care physicians&#46; Training took place by teleconsultation at 33&#37; of centers&#44; in seminars and meetings in 17&#37; of centers&#44; and by both methods in 31&#37; of centers&#46; Sixty-six percent of the centers used TD for teaching in 2014 and a similar percentage was reported in 2009&#46; In contrast&#44; just 20&#37; of the centers carried out patient satisfaction surveys&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">E&#46; Advantages and disadvantages</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;<span class="elsevierStyleItalic">&#58;</span> On a scale of 0 to 10&#44; mean overall satisfaction with TD increased from 6&#46;3 points in 2009 to 6&#46;9 points in 2014&#46; The main advantages and disadvantages of TD perceived by dermatologists were similar in 2009 and 2014&#46; Among the main advantages were patient prioritization and communication with family doctors&#59; in both surveys&#44; poor photo quality was the main disadvantage reported&#46; Internet connection speed was a problem for some centers in 2009&#44; but not in 2014&#46; The dermatologists assessed the various advantages and disadvantages on a scale of 0 to 10 in 2014&#59; the results are shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">As for overall trends&#44; between 2009 and 2014 there was an increase in the number of centers using TD&#44; the number of teledermatologists per center&#44; the time spent on TD&#44; the quality of technology and organization&#44; the number of centers using store-and-forward TD systems&#44; and the use of TD in urban settings &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">This study attempted to characterize the Spanish health care facilities that used TD in 2014 and to analyze changes and trends since 2009&#46; Our findings show that TD is an emerging technology in Spain &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Between 2009 and 2014&#44; the number of centers using TD in Spain practically tripled&#46; Moreover&#44; each center had more teledermatologists on staff&#44; spent more time on TD&#44; was better organized&#44; and had better technology in 2014 than in 2009&#46; There was also an incremental increase in the use of store-and-forward TD at the expense of real-time TD systems&#44; as well as a trend towards more urban use of TD &#40;in order words&#44; the use of TD with patients who live closer the hospital&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Our study had some methodological limitations&#46; The use of online surveys as a study method limited the response rate and left open the possibility of inaccurate responses&#46; The initial methods of contacting the dermatologists were different in 2009 and 2014&#44; so it is possible that undetected differences might exist&#46; Some departments that actively use TD did not respond to the survey&#59; this could be considered selection bias&#46; Exhaustivity of access was the main advantage of our study&#44; especially in 2014&#44; when in-person access to 267 centers was achieved&#46; Other strengths were the wealth and variety of the topics studied&#44; as well as the high response rate among centers that use TD&#44; both in 2009 and in 2014&#46; These strengths suggest that the data obtained are representative and reliable&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Two longitudinal studies have analyzed the evolution of TD use in the United States&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a> These studies found similar trends to those identified in Spain&#58; an increase in TD use overall and in the use of store-and-forward models in particular&#46; Although the number of TD programs in the United States fell from 62 in 2003 to 37 in 2011&#44; the annual volume of consultations per center increased significantly&#44; nearly doubling&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> Thus&#44; one of the largest TD programs in the United States&#8212;that of the Veterans Health Administration &#40;VHA&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a>&#8212;showed rapid growth in the number of TD consultations in recent years&#46; As in Spain&#44; TD in the United States has been shifting away from real-time methods &#40;videoconference technology&#41; since 2007&#44; in favor of modalities involving the storage of still photographs&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11&#44;12</span></a> Nowadays&#44; store-and-forward is the predominant TD technology&#44; probably because of its low cost&#44; higher image quality&#44; and the fact that an asynchronous approach allows for better organization and greater efficiency&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Only 1 transversal study has offered a comprehensive&#44; in-depth analysis of TD models over a large geographical area&#46; In this study&#44; Armstrong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">10</span></a> studied TD in California&#8212;the most populous US state&#44; with 38 million inhabitants&#8212;between 2007 and 2011&#46; The authors identified just 17 teledermatologists working actively in 2011&#8212;a figure that stands in stark contrast to the 105 teledermatologists identified in 2014 in Spain&#44; which has a population &#40;46 million inhabitants&#41; similar to that of California&#46; The number of teledermatologists per million inhabitants was clearly lower in California &#40;&#46;44&#41; than in Spain &#40;2&#46;28&#41;&#46; In California&#44; as in our study&#44; the predominant TD model was store-and-forward &#40;70&#37;&#41;&#59; however&#44; hybrid systems were used by a larger percentage of teledermatologists in California &#40;18&#37;&#41;&#46; As in Spain&#44; the percentage of teledermatologists using only real-time TD was very low &#40;6&#37;&#41;&#46; Mean experience with TD was similar in California and Spain &#40;3&#46;85 and 4&#46;9 years&#44; respectively&#41;&#46; However&#44; the objectives of TD use were different in Spain and California&#46; In California&#44; 75&#37; of patients seen by TD had a low socioeconomic status and lived in remote rural areas&#46; In contrast&#44; most centers that used TD in Spain were concentrated in large cities &#40;Seville&#44; Madrid&#44; and Barcelona&#41; and this technology was used to see all types of patients&#46; In their discussion section&#44; Armstrong et al&#46; describe TD as a rapidly evolving field but note that this technique should logically always serve as a complement to face-to-face options&#46; The authors predict that future TD use will not be limited to rural communities or citizens at risk of exclusion&#46; We agree with this view and our results support this theory&#59; in Spain&#44; the urban focus of TD is already a reality&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> as is the rapid development of TD in heavily populated areas of Europe such as the Netherlands and the United Kingdom&#46; It is possible that the use of TD in the United States will begin to catch up with the European model&#46; In fact&#44; in the VHA program&#44; patients seen by TD in urban areas have outnumbered patients in rural areas since 2012&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The advantages described by Californian teledermatologists are similar to those reported by Spanish teledermatologists&#58; greater efficiency&#44; access&#44; speed of care&#44; and patient satisfaction&#46; The main disadvantages were somewhat different&#59; Californian dermatologists reported problems with reimbursement for teleconsultations as well as costly and inefficient software&#46; In other areas&#44; however&#44; Californian and Spanish dermatologists voiced similar concerns&#46; In both places&#44; image quality and complex skin conditions were the main factors that limited the ability of TD to prevent face-to-face consultations&#46; Moreover&#44; on both sides of the Atlantic&#44; dermatologists agreed that store-and-forward TD should not replace face-to-face consultations entirely&#46; The option of face-to-face consultations should always exist&#44; and for some conditions&#8212;for example&#44; a patient with multiple pigmented lesions&#8212;face-to-face consultation is the only option and assessment by TD is contraindicated&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;8&#44;13</span></a> Technological and legal considerations are also important barriers but can probably be overcome in the near future&#46; According to the sample surveyed in our study&#44; this trend towards future technological improvements appears to be evident&#46; Potential improvements in the area of legal issues were not measured in the survey&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Despite these and other challenges in telemedicine&#44; the development of TD appears to be unstoppable&#46; In 2010&#44; 38&#37; of countries had some sort of TD program and 30&#37; had governmental agencies dedicated to this practice&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a> Multiple studies have provided evidence to support the reliability &#40;agreement between diagnosis and management&#41; and accuracy &#40;validity compared to a gold standard&#41; of TD&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> Store-and-forward TD has been shown to be effective in reducing the number of face-to-face consultations in hospitals&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">15</span></a> Face-to-face consultations and store-and-forward TD have shown similar results in terms of clinical improvement and time to intervention in patients with skin cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3&#44;16</span></a> In recent years&#44; there has been a considerable increase in the number of successful TD programs for managing skin cancer<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> and for providing a rapid response in large urban areas&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> Patients have reported high satisfaction and a willingness to pay out of pocket to access TD services&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> TD has been shown to be cost-effective when used as a triage mechanism to reduce appointments and travel<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> and to reduce the time to the initial intervention&#46; TD is currently seen as a solution for many deficiencies in health systems&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">19&#8211;21</span></a> The technique can be used to increase accessibility for patients who live in remote areas or in geriatric facilities&#44; prioritize cancer diagnosis&#44; prevent referrals for trivial disease&#44; and accelerate care in cases of emergency&#44; among other benefits&#46; The opinions of the Spanish dermatologists &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41; who use and understand TD support these views &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Assessed on a scale of 0 to 10&#44; the median score for advantages such as improved communication with primary care physicians&#44; screening for trivial conditions&#44; reduction in the number of face-to-face visits&#44; and prioritization of conditions requiring urgent care and cancers was higher than 8&#46; The main problems or disadvantages&#44; also assessed on a scale of 0 to 10 &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#44; received clearly lower scores &#40;median score<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; with the exception of risk of error and poor photo quality &#40;median score<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#41;&#46; Indeed&#44; the reliability of TD is the parameter that has been most widely studied&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">14</span></a> The reliability of TD has been shown to be comparable to that of face-to-face consultation for diagnosis and management&#44; although logically the photographs must be of sufficient quality in order for TD to achieve this reliability in diagnosis and management&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our view&#44; the main achievement of TD in Spain has been to improve the quality of health care processes&#44; and this fact explains the considerable development of TD that has taken place in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> TD use has also increased in other developed countries&#44; such as the United States and European countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">22&#8211;25</span></a> In the United States&#44; TD use increased from 7&#37; to 11&#37; between 2012 and 2014&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> In the Netherlands&#44; TD is fully reimbursed and integrated in the national health system&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">22</span></a> The use of TD is also on the rise in the United Kingdom&#44; where resistance to this technique among dermatologists is decreasing&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a> Developing countries&#44; meanwhile&#44; are probably just beginning to apply this technique&#46; A recent study in South Africa found no evidence of the scaling of TD services or of the integration of TD into routine health care&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Our study showed that the development of TD in Spain is considerable but that there is still much room for improvement&#44; and that it is important not only to increase the number of TD programs but also to improve their quality&#46; Health care providers must give dermatologists sufficient time for teleconsultations and adequate resources &#40;software integrated with diagnostic coding&#44; quality cameras and dermoscopes&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion&#44; TD is an emerging technology that is becoming well established in Spain&#46; In 2014&#44; more than 25&#37; of public dermatology centers in Spain had introduced a TD system&#46; The levels of development and implementation of TD appear to be higher in Spain than in countries on the cutting edge of telemedicine such as the United States&#46; The predominant model in Spain&#8212;store-and-forward TD in urban settings&#8212;is similar to that of the Netherlands&#44; and the United States appears to be adopting this trend&#46; In line with findings in other countries&#44; Spanish dermatologists perceive TD as an effective option with more advantages than disadvantages&#46; Dermatologists are generally highly satisfied with TD&#44; although there are still areas in need of significant improvement&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of Interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1077281"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Introduction"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusion"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1023309"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1077282"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1023308"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of Interest"
        ]
        9 => array:2 [
          "identificador" => "xack364960"
          "titulo" => "Acknowledgments"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-12-14"
    "fechaAceptado" => "2018-03-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1023309"
          "palabras" => array:4 [
            0 => "Telemedicine"
            1 => "Teledermatology"
            2 => "Teleconsultation"
            3 => "Health service research"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1023308"
          "palabras" => array:4 [
            0 => "Telemedicina"
            1 => "Teledermatolog&#237;a"
            2 => "Teleconsulta"
            3 => "Investigaci&#243;n en servicios de salud"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Teledermatology is the most advanced clinical specialty in telemedicine&#46; The development of teledermatology in specific countries has not been studied in depth&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Our objective was to analyze teledermatology models in clinical practice in Spain&#46; We paid special attention to organization&#44; technical aspects&#44; training&#44; and the advantages&#47;disadvantages as seen by teledermatologists&#46; Two surveys were carried out &#40;2009 and 2014&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Teledermatology was used at 25 centers in 2009 and at 70 in 2014&#46; The extended survey was completed by 21 centers in 2009 and 41 in 2014&#46; Store-and-forward teledermatology was the main technique &#40;83&#37;&#41; in 2014&#46; Only 12&#37; of centers used the real-time method&#44; and 5&#37; used a hybrid modality&#46; Patients lived less than 25<span class="elsevierStyleHsp" style=""></span>km away in 75&#37; of cases &#40;urban teledermatology&#41;&#46; Most centers used mid-range bridge cameras&#59; only 12&#37; used mobile phones&#46; Teledermoscopy and tertiary teledermatology were each used in 15&#37; of centers&#46; Teledermatology was restricted to skin cancer in 25&#37; of cases&#44; and 66&#37; of centers used it to train primary care physicians&#46; The main advantages&#44; assessed on a scale of 1 to 10&#44; were prioritization in cancer screening &#40;8&#46;3&#41;&#44; rapid emergency care &#40;7&#46;8&#41;&#44; training of and communication with primary care physicians &#40;7&#46;6&#41;&#44; screening for trivial conditions &#40;7&#46;6&#41;&#44; and reduction in the number of face-to-face visits &#40;7&#46;6&#41;&#46; The main disadvantages were poor image quality &#40;6&#46;3&#41;&#44; fear of error &#40;5&#46;7&#41;&#44; difficulty in coordinating with primary care physicians &#40;3&#46;8&#41;&#44; and time commitment &#40;3&#46;3&#41;&#46; Between 2009 and 2014&#44; the number of centers using teledermatology and the number of teledermatologists increased&#44; as did use of the store-and-forward and urban models&#46; The technology used also improved&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Teledermatology is an emerging technology that is becoming well established in Spain&#46; More than 25&#37; of dermatology centers in Spain have implemented a teledermatology model&#46; Store-and-forward in an urban setting is the most widely used modality&#46; Teledermatologists see this technology as an effective option with more advantages than disadvantages&#46; General satisfaction is high&#44; although there is room for significant improvement in some areas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusion"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La teledermatolog&#237;a &#40;TD&#41; es la especialidad cl&#237;nica m&#225;s desarrollada de la telemedicina&#46; El desarrollo de la TD en un pa&#237;s completo no se ha estudiado previamente en profundidad&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El objetivo fue analizar los modelos de TD en pr&#225;ctica real en Espa&#241;a&#44; centr&#225;ndose en la organizaci&#243;n&#44; los aspectos t&#233;cnicos&#44; la docencia y las ventajas&#47;desventajas percibidas por los teledermat&#243;logos&#46; Se realizaron 2<span class="elsevierStyleHsp" style=""></span>encuestas con teledermat&#243;logos en 2009 y 2014&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 25 centros utilizando TD en 2009 y 70 en 2014&#46; La encuesta ampliada fue completada por 21 centros en 2009 y 42 en 2014&#46; Las caracter&#237;sticas generales en 2014 fueron&#58; TD almacenamiento &#40;TDA&#41; fue la t&#233;cnica predominante &#40;83&#37;&#41;&#44; solo el 12&#37; TD en tiempo real y el 5&#37; TD h&#237;brida&#46; El 75&#37; de los pacientes vistos en TD viven a menos de 25 km &#40;TD urbana&#41;&#46; La mayor&#237;a de los centros utilizan c&#225;maras bridge de gama media y solo el 12&#37; utiliza los tel&#233;fonos m&#243;viles&#46; El 15&#37; practica teledermoscopia y el 15&#37; TD terciaria&#46; En el 25&#37;&#44; la TD se restringi&#243; a la oncolog&#237;a cut&#225;nea&#59; el 66&#37; utiliza la TD para formaci&#243;n de m&#233;dicos de primaria&#46; Las ventajas principales &#40;puntuaci&#243;n 0-10&#41; fueron priorizaci&#243;n en oncolog&#237;a &#40;8&#44;3&#41;&#44; asistencia r&#225;pida de urgencias &#40;7&#44;8&#41;&#44; la formaci&#243;n y la comunicaci&#243;n con los m&#233;dicos de primaria &#40;7&#44;6&#41;&#44; el cribado de enfermedad banal &#40;7&#44;6&#41; y la disminuci&#243;n de las visitas presenciales &#40;7&#44;6&#41;&#46; Los principales inconvenientes fueron &#40;puntuaci&#243;n 0-10&#41;&#58; la baja calidad de im&#225;genes &#40;6&#44;3&#41;&#44; el miedo al error &#40;5&#44;7&#41;&#44; dif&#237;cil coordinaci&#243;n con los m&#233;dicos de primaria &#40;MP&#41; &#40;3&#44;8&#41; y consumo de tiempo &#40;3&#44;3&#41;&#46; La evoluci&#243;n 2009-2014 mostr&#243; m&#225;s centros con TD y m&#225;s teledermat&#243;logos&#44; mejor tecnolog&#237;a y aumento de los modelos TDA y urbano&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La TD es una tecnolog&#237;a emergente que comienza su fase de consolidaci&#243;n en Espa&#241;a&#46; M&#225;s del 25&#37; de los centros de dermatolog&#237;a en Espa&#241;a han puesto en pr&#225;ctica un sistema de TD&#46; El modelo predominante es TDA en un entorno urbano&#46; Los dermat&#243;logos perciben la TD como una opci&#243;n efectiva con m&#225;s ventajas que desventajas&#46; La satisfacci&#243;n general es alta&#44; sin embargo&#44; todav&#237;a hay &#225;reas que necesitan mejoras significativas&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Romero G&#44; de Argila D&#44; Ferrandiz L&#44; S&#225;nchez MP&#44; Va&#241;&#243; S&#44; Taberner R&#44; et al&#46; Modelos de pr&#225;ctica de la teledermatolog&#237;a en Espa&#241;a&#46; Estudio longitudinal 2009-2014&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;624&#8211;630&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1751
            "Ancho" => 2385
            "Tamanyo" => 284041
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Spanish centers that use teledermatology by autonomous community&#44; 2009 vs 2014 &#40;25 in 2009&#59; 70 in 2014&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 877
            "Ancho" => 1441
            "Tamanyo" => 68174
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Models of teledermatology in Spain&#44; 2009 vs 2014&#46;</p> <p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; S&#38;FTD&#44; store-and-forward teledermatology &#40;still photography&#41;&#59; RTTD&#44; real-time teledermatology &#40;videoconference&#41;&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 978
            "Ancho" => 2586
            "Tamanyo" => 150635
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Advantages and disadvantages of using a TD system in 2014 &#40;dermatologist&#39;s perspective on a scale of 0 to 10&#41;&#46; The main advantages are scored on a scale of 0 &#40;strongly disagree&#41; to 10 &#40;fully agree&#41;&#46; The main disadvantages or problems are scored on a scale of 0 &#40;nonexistent problem&#41; to 10 &#40;the problem is very serious and difficult to solve&#41; &#40;n &#61; 42&#59; ranges and medians&#41;&#46; TD indicates teledermatology&#59; PC&#44; primary care&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Overall Comparison</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Centers using TD</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Departments that completed the survey</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Experience with TD &#40;mean and range in years&#41;</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;1 &#40;0&#46;2-14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;9 &#40;0&#46;5-17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">TD modality</td><td class="td" title="table-entry  " align="left" valign="top">Store-and-forward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67&#37; &#40;14&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#37; &#40;35&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Real-time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#37; &#40;5&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#37; &#40;5&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Decrease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hybrid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#37; &#40;2&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;5&#37; &#40;2&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Decrease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Skin diseases assessed by TD</td><td class="td" title="table-entry  " align="left" valign="top">All types&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62&#37; &#40;13&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&#37; &#40;34&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer only&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#37; &#40;7&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#44;6&#37; &#40;7&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Decrease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7&#37; &#40;1&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;4&#37; &#40;1&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Similar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Hours per week spent on TD &#40;mean and range&#41;</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1-12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;67 &#40;0&#46;5-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Number of dermatologists practicing TD in each department &#40;mean and range&#41;</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;3 &#40;1-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;8 &#40;1-7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Greatest distance between center and TD patient</td><td class="td" title="table-entry  " align="left" valign="top">Less than 50 km&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#37; &#40;6&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46&#37; &#40;17&#47;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Between 50 and 100 km&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#37; &#40;8&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#37; &#40;16&#47;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">More than 100 km&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#37; &#40;7&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#37; &#40;4&#47;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Decrease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">TD software integrated into hospital information system</td><td class="td" title="table-entry  " align="left" valign="top">33&#37; &#40;7&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#37; &#40;28&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Increase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Training objectives for primary care physicians &#40;e-learning&#41;</td><td class="td" title="table-entry  " align="left" valign="top">61&#37; &#40;13&#47;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66&#37; &#40;28&#47;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Similar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1838874.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Comparison of 2009 and 2014 Survey Findings&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:26 [
            0 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "WHO&#46; Telemedicine&#58; Opportunities and developments in member states&#46; Geneva&#44; Switzerland&#58; World Health Organization&#59; 2010&#46; p&#46; 1-96&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Telemedicine and teledermatology &#40;I&#41;&#58; Concepts and applications&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Romero"
                            1 => "J&#46;A&#46; Garrido"
                            2 => "M&#46; Garcia-Arpa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "506"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18682163"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039606015003219"
                          "estado" => "S300"
                          "issn" => "00396060"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology&#58; From historical perspective to emerging techniques of the modern era&#58; Part I&#58; History&#44; rationale&#44; and current practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Coates"
                            1 => "J&#46; Kvedar"
                            2 => "R&#46;D&#46; Granstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2014.07.061"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2015"
                        "volumen" => "72"
                        "paginaInicial" => "563"
                        "paginaFinal" => "574"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25773407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology&#58; From the tempest of debate to calmer waters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Moreno-Ramirez"
                            1 => "G&#46; Romero-Aguilera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2016.01.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2016"
                        "volumen" => "107"
                        "paginaInicial" => "366"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26956401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Hersh WR&#44; Hickam DH&#44; Severance DS&#46; Telemedicine for the Medicare Population&#58; Update&#46; In&#58; Agency for Healthcare Research and Quality&#44; editor&#46; AHRQ Publication No&#46; 06-E007&#46; 2006&#46;"
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Totten AM&#44; Omack DM&#44; Eden KB&#44; McDonagh AJ&#44; Griffin JC&#44; Grusing S&#44; et al&#46; Telehealth&#58; Mapping the evidence for patient outcomes from systematic reviews&#46; AHRQ Publication No&#46;16-EHC034-EF&#46; 2016&#46;"
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maturity of teledermatology evaluation research&#58; A systematic literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46; Eminovic"
                            1 => "N&#46;F&#46; de Keizer"
                            2 => "P&#46;J&#46; Bindels"
                            3 => "A&#46; Hasman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2006.07627.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "412"
                        "paginaFinal" => "419"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17300227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Has teledermatology in the U&#46;K&#46; finally failed&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;S&#46; English"
                            1 => "D&#46;J&#46; Eedy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2007.07750.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2007"
                        "volumen" => "156"
                        "paginaInicial" => "411"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17300226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;P&#46; Van der Heijden"
                            1 => "N&#46;F&#46; de Keizer"
                            2 => "J&#46;D&#46; Bos"
                            3 => "P&#46;I&#46; Spuls"
                            4 => "L&#46; Witkamp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.2011.10509.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2011"
                        "volumen" => "165"
                        "paginaInicial" => "1058"
                        "paginaFinal" => "1065"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21729026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Practice models and challenges in teledermatology&#58; A study of collective experiences from teledermatologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;W&#46; Armstrong"
                            1 => "M&#46;W&#46; Kwong"
                            2 => "L&#46; Ledo"
                            3 => "T&#46;S&#46; Nesbitt"
                            4 => "S&#46;L&#46; Shewry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0028687"
                      "Revista" => array:6 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "e28687"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22194887"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039606015008168"
                          "estado" => "S300"
                          "issn" => "00396060"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "State of teledermatology programs in the United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;W&#46; Armstrong"
                            1 => "J&#46; Wu"
                            2 => "C&#46;L&#46; Kovarik"
                            3 => "M&#46;E&#46; Goldyne"
                            4 => "D&#46;H&#46; Oh"
                            5 => "K&#46;C&#46; McKoy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2012.02.019"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2012"
                        "volumen" => "67"
                        "paginaInicial" => "939"
                        "paginaFinal" => "944"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology within the Veterans Health Administration&#44; 2002-2014"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;M&#46; Landow"
                            1 => "D&#46;H&#46; Oh"
                            2 => "M&#46;A&#46; Weinstock"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1089/tmj.2014.0225"
                      "Revista" => array:6 [
                        "tituloSerie" => "Telemed J E Health"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "769"
                        "paginaFinal" => "773"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26083585"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A 10-year history of teledermatology for skin cancer management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46; Moreno-Ramirez"
                            1 => "L&#46; Ferrandiz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2015"
                        "volumen" => "14"
                        "paginaInicial" => "1"
                        "paginaFinal" => "2"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Telemedicine and teledermatology &#40;II&#41;&#58; Current state of research on dermatology teleconsultations&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Romero"
                            1 => "P&#46; Cortina"
                            2 => "E&#46; Vera"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2008"
                        "volumen" => "99"
                        "paginaInicial" => "586"
                        "paginaFinal" => "597"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19080890"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals&#58; Proposal for quantitative synthesis in a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Wootton"
                            1 => "K&#46; Bahaadinbeigy"
                            2 => "D&#46; Hailey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6963-11-185.:185-11"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21824388"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma&#58; A cross-sectional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Moreno-Ramirez"
                            1 => "T&#46; Ojeda-Vila"
                            2 => "J&#46;J&#46; Rios-Martin"
                            3 => "R&#46; Ruiz-Villaverde"
                            4 => "M&#46; de-Troya"
                            5 => "A&#46; Sanz-Trelles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2014.04.049"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2014"
                        "volumen" => "71"
                        "paginaInicial" => "507"
                        "paginaFinal" => "515"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24894454"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039606015006364"
                          "estado" => "S300"
                          "issn" => "00396060"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology for the diagnosis and management of skin cancer&#58; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Finnane"
                            1 => "K&#46; Dallest"
                            2 => "M&#46; Janda"
                            3 => "H&#46;P&#46; Soyer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2016"
                        "volumen" => "7"
                        "paginaInicial" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of store-and-forward teledermatology&#58; A systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Snoswell"
                            1 => "A&#46; Finnane"
                            2 => "M&#46; Janda"
                            3 => "H&#46;P&#46; Soyer"
                            4 => "J&#46;A&#46; Whitty"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2016.0525"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2016"
                        "volumen" => "152"
                        "paginaInicial" => "702"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27074289"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Teledermatology is the answer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;J&#46; Motley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.e6593"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2012"
                        "volumen" => "345"
                        "paginaInicial" => "e6593"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23033424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The teledermatology train is coming&#58; Get on board&#44; get out of the way&#44; or get run over"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;E&#46; Burdick"
                            1 => "S&#46;C&#46; Simmons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Cutis"
                        "fecha" => "2011"
                        "volumen" => "88"
                        "paginaInicial" => "213"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22272479"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0039606015008946"
                          "estado" => "S300"
                          "issn" => "00396060"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Teledermatology&#58; Diagnosis&#44; triage and effective care of dermatology&#46; NHS Bristol 2012 November 5 &#91;cited 2015 Dec 5&#93;&#46; Available from&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.evidence.nhs.uk/qipp">http&#58;&#47;&#47;www&#46;evidence&#46;nhs&#46;uk&#47;qipp</a>"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Two decades of teledermatology&#58; Current status and integration in national healthcare systems"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Tensen"
                            1 => "J&#46;P&#46; van der Heijden"
                            2 => "M&#46;W&#46; Jaspers"
                            3 => "L&#46; Witkamp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13671-016-0136-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Dermatol Rep"
                        "fecha" => "2016"
                        "volumen" => "5"
                        "paginaInicial" => "96"
                        "paginaFinal" => "104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27182461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of teledermatology on access to dermatology care among Medicaid enrollees"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Uscher-Pines"
                            1 => "R&#46; Malsberger"
                            2 => "L&#46; Burgette"
                            3 => "A&#46; Mulcahy"
                            4 => "A&#46; Mehrotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2016.0938"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Dermatol"
                        "fecha" => "2016"
                        "volumen" => "152"
                        "paginaInicial" => "905"
                        "paginaFinal" => "912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27144986"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in dermatology practices and the implications for the workforce"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Ehrlich"
                            1 => "J&#46; Kostecki"
                            2 => "H&#46; Olkaba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2017.06.030"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2017"
                        "volumen" => "77"
                        "paginaInicial" => "746"
                        "paginaFinal" => "752"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28784330"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673603147460"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Changing use and attitudes towards teledermatology in the UK over 10 years&#58; Results of the 2016 National Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;H&#46; Mehrtens"
                            1 => "S&#46;M&#46; Halpern"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "2017"
                        "volumen" => "26"
                        "paginaInicial" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review and critique of teledermatology in the South African Public Health Sector"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;E&#46; Walters"
                            1 => "M&#46; Mars"
                            2 => "R&#46;E&#46; Scott"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stud Health Technol Inform"
                        "fecha" => "2016"
                        "volumen" => "231"
                        "paginaInicial" => "143"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27782026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
    "agradecimientos" => array:1 [
      0 => array:4 [
        "identificador" => "xack364960"
        "titulo" => "Acknowledgments"
        "texto" => "<p id="par0105" class="elsevierStylePara elsevierViewall">We are grateful to the AbbVie sales network for collaborating on the distribution and collection of the surveys in 2014&#46;</p>"
        "vista" => "all"
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010900000007/v1_201809020417/S1578219018302245/v1_201809020417/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6155"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000007/v1_201809020417/S1578219018302245/v1_201809020417/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018302245?idApp=UINPBA000044"
]

Article information

ISSN: 15782190
Original language: English

DOI:10.1016/j.adengl.2018.06.013

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	10	11	21
2024 October	77	34	111
2024 September	67	35	102
2024 August	93	47	140
2024 July	82	38	120
2024 June	73	33	106
2024 May	70	38	108
2024 April	74	33	107
2024 March	66	32	98
2024 February	60	40	100
2024 January	33	27	60
2023 December	51	23	74
2023 November	55	27	82
2023 October	58	27	85
2023 September	56	30	86
2023 August	38	11	49
2023 July	53	32	85
2023 June	57	27	84
2023 May	43	30	73
2023 April	45	29	74
2023 March	48	39	87
2023 February	41	27	68
2023 January	39	42	81
2022 December	63	52	115
2022 November	23	46	69
2022 October	43	21	64
2022 September	29	54	83
2022 August	25	61	86
2022 July	24	35	59
2022 June	40	33	73
2022 May	39	47	86
2022 April	60	44	104
2022 March	62	59	121
2022 February	61	33	94
2022 January	75	46	121
2021 December	59	51	110
2021 November	66	45	111
2021 October	55	64	119
2021 September	50	46	96
2021 August	56	50	106
2021 July	47	36	83
2021 June	44	42	86
2021 May	65	55	120
2021 April	99	154	253
2021 March	88	61	149
2021 February	69	56	125
2021 January	47	37	84
2020 December	61	61	122
2020 November	55	40	95
2020 October	39	26	65
2020 September	55	35	90
2020 August	40	33	73
2020 July	36	27	63
2020 June	58	51	109
2020 May	35	31	66
2020 April	21	15	36
2020 March	30	17	47
2020 February	2	0	2
2020 January	3	2	5
2019 December	2	4	6
2019 July	5	2	7
2018 November	107	0	107
2018 October	1	0	1
2018 September	1	0	1

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter