Commentaries
Teledermatology: A Tool to Bridge the Gap Between Primary and Specialized Care
La teledermatología, un puente que construir entre primaria y especializada
G. Romero-Aguilera
, J.A. Garrido-Martin
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Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
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Romero-Aguilera, J.A. Garrido-Martin" "autores" => array:2 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Romero-Aguilera" "email" => array:1 [ 0 => "gromeroa@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Garrido-Martin" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La teledermatología, un puente que construir entre primaria y especializada" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The lack of information on outpatient clinic activity in specialized care in Spain is well known; hence the importance of studies such as the valuable DIADERM study, which analyzes the practice of dermatology in Spain.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,2</span></a> A total of 80 dermatologists agreed to participate in the study over 6 days in 2016. If the number of consultations is extrapolated to the total held by dermatologists in Spain, this is equivalent to 621 000 consultations/month or 7.46 million per year, that is 16% of the Spanish population in 2016. Of these consultations, 68% were in public centers and 32% in private centers. These extremely high figures are similar to those published in the USA <a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a>and UK,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> which indicate that every year, 25% of the population consults a physician because of a skin disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The DIADERM <a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a>study shows that in private medicine in Spain, where patients can choose freely, they prefer to visit the dermatologist directly. Barely 7% of patients are referred to a dermatologist from private primary care clinics. In contrast, in public clinics, where direct access is impossible, primary care acts as a filter, thus controlling access. Much has been written about the suitability of one or the other model, namely, direct access or filtering through primary care.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Particularly revealing is the debate that started in 2012 in <span class="elsevierStyleItalic">BMJ</span>,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4,5</span></a> where teledermatology <a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a>surfaced as a response to the need for improvement in training and tutoring of primary care physicians so that they can play their role in this model. It is precisely in consultation via telemedicine—barely covered in the first article<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a>—where the authors focus their analysis in this issue of <span class="elsevierStyleSmallCaps">Actas</span>.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> While, more than 25% of public health centers, especially the larger ones, had active teledermatology systems in place in 2014,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> it is noteworthy that in the DIADERM study, only 1.2% of dermatology consultations were via teledermatology (95% CI, 0.4-3.7%). And this is not because the teledermatology continues to be supplementary approach in private centers: 36% of consultations in private clinics are by teledermatology compared with 30% for face-to-face consultations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">When we consider distribution by autonomous community,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,7</span></a> we see that teledermatology is widespread, although volumes of use remain low. Therefore, the benefits of teledermatology <a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a>for prioritization of cancer and emergency cases, improved access for elderly or disabled persons, and training/coordination with primary care are underexploited in Spain.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Studies show that teledermatology is an emerging field.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,7</span></a> It is necessary to continue to assess the extent of its implementation and to ensure that it is used appropriately following the recommendations of the AEDV.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romero-Aguilera G, Garrido-Martin J. La teledermatología, un puente que construir entre primaria y especializada. Actas Dermosifiliogr. 2019;110:91.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de los diagnósticos realizados en la actividad ambulatoria dermatológica en España: muestreo aleatorio nacional DIADERM" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Buendía-Eisman" 1 => "S. Arias-Santiago" 2 => "A. Molina-Leyva" 3 => "Y. Gilaberte" 4 => "P. Fernández-Crehuet" 5 => "H. 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| 2022 Noviembre | 30 | 24 | 54 |
| 2022 Octubre | 36 | 33 | 69 |
| 2022 Septiembre | 30 | 38 | 68 |
| 2022 Agosto | 27 | 32 | 59 |
| 2022 Julio | 29 | 38 | 67 |
| 2022 Junio | 27 | 29 | 56 |
| 2022 Mayo | 33 | 30 | 63 |
| 2022 Abril | 23 | 29 | 52 |
| 2022 Marzo | 26 | 45 | 71 |
| 2022 Febrero | 27 | 17 | 44 |
| 2022 Enero | 30 | 28 | 58 |
| 2021 Diciembre | 29 | 33 | 62 |
| 2021 Noviembre | 35 | 32 | 67 |
| 2021 Octubre | 43 | 40 | 83 |
| 2021 Septiembre | 24 | 29 | 53 |
| 2021 Agosto | 26 | 18 | 44 |
| 2021 Julio | 18 | 20 | 38 |
| 2021 Junio | 26 | 21 | 47 |
| 2021 Mayo | 30 | 28 | 58 |
| 2021 Abril | 89 | 34 | 123 |
| 2021 Marzo | 42 | 20 | 62 |
| 2021 Febrero | 45 | 18 | 63 |
| 2021 Enero | 30 | 14 | 44 |
| 2020 Diciembre | 23 | 11 | 34 |
| 2020 Noviembre | 20 | 15 | 35 |
| 2020 Octubre | 23 | 14 | 37 |
| 2020 Septiembre | 28 | 13 | 41 |
| 2020 Agosto | 19 | 17 | 36 |
| 2020 Julio | 18 | 11 | 29 |
| 2020 Junio | 22 | 19 | 41 |
| 2020 Mayo | 20 | 13 | 33 |
| 2020 Abril | 13 | 7 | 20 |
| 2020 Marzo | 11 | 7 | 18 |
| 2020 Febrero | 2 | 0 | 2 |
| 2020 Enero | 2 | 2 | 4 |
| 2019 Octubre | 1 | 0 | 1 |
| 2019 Julio | 51 | 2 | 53 |
| 2019 Mayo | 1 | 1 | 2 |
| 2019 Marzo | 4 | 2 | 6 |
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