Información del artículo
Abstract
The rapid increase in the use of telemedicine makes a critical appraisal of these services essential. This article reviews the current evidence from studies of teledermatology with sufficiently rigorous methodology to allow reasonable conclusions to be drawn. The review is organized according to areas of research in teledermatology: reliability of diagnosis and management, accuracy, outcomes, costs, and satisfaction. The conclusion of this review is that teledermatology has been shown to be feasible and reliable but that it has a long way to go before maturing as a medical technology in daily practice. The largest body of evidence relates to the reliabity of diagnosis and management, but although numerous studies have been performed, many have marked methodological shortcomings. Accuracy studies have been conducted in skin oncology with appropriate methodology that show an accuracy comparable to that of face-to-face consultations. Studies of health outcomes should be designed such that a faithful assessment of the final outcomes, costs, and satisfaction with teledermatology systems can be carried out.
Key words:
telemedicine
teleconsultation
teledermatology
store-and-forward systems
real-time systems
reproducibility of results
validation studies
outcomes assessment
costs analysis
personal satisfaction
Resumen
El rápido incremento en el desarrollo de los servicios en telemedicina hace crucial su evaluación crítica. Este artículo revisa la evidencia actual en artículos de investigación en teledermatología con la suficiente calidad metodológica como para alcanzar conclusiones razonables. La revisión se organiza analizando las áreas de investigación en teledermatología: fiabilidad en el diagnóstico y el manejo, validez, resultados, costes y satisfacción. Las conclusiones de la misma indican que la teledermatología ha demostrado ser factible y fiable pero que está lejos de alcanzar su madurez como tecnología médica para su práctica habitual. El cuerpo de evidencia con mayor desarrollo es el área de fiabilidad en el diagnóstico y el manejo, donde existen un gran número de estudios, aunque muchos de ellos adolecen de importantes defectos metodológicos. Existen estudios de validez en oncología cutánea con metodología correcta que muestran unos resultados comparables con la consulta presencial. Se hace preciso el diseño de estudios en resultados de salud que permitan un análisis fidedigno de resultados finales, costes y satisfacción de los sistemas de teledermatología.
Palabras clave:
telemedicina
teleconsulta
teledermatología
sistemas de almacenamiento
sistemas en tiempo real
reproducibilidad de los resultados
estudios de validación
análisis de resultados
análisis de costes
satisfacción personal
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