背景：eConsult是一种不断发展的远程皮肤病学工具，有可能解决健康差异。在大流行的背景下，远程皮肤病学的使用趋势仍在定义中，大流行后恢复，以及越来越多的非医师初级保健提供者。目标：目的是了解地理位置广阔的德克萨斯州异步皮肤病学eConsults的远程皮肤病学利用趋势。方法：这项多中心回顾性研究检查了eConsult工具，非营利性卫生系统，比较了2022年1月至2023年3月893次eConsult访视与27,189次当面皮肤科就诊的特征。结果：当比较通过eConsult与传统的当面访问看到的患者的人口统计学时，eConsults显示儿科患病率明显更高(22.5%vs.7.6%,p<0.001)，西班牙裔/拉丁裔（20.5%vs.10.4%,p<0.001)，非裔美国人（12.5%vs.6.9%，p<0.001)，亚洲（4.6%与2.1%,p<0.001)，和美洲印第安人(1.0%对0.5%,p=0.049）患者与亲自就诊相比。eConsult用户来自学士学位持有者比例较低的地区，家庭平均收入减少，以及医疗补助和Tricare用户的比例增加。医师(MD/DO)提交的eConsult病例比非医师提供者(NPP)多，与远程皮肤科医生有相当的诊断一致性，并且对当面皮肤科就诊的推荐率相似。结论：虽然这项研究的局限性在于它是在单一医疗保健系统中进行的描述性数据分析，具有有限的泛化性，eConsults承诺扩大服务不足群体的皮肤病学准入，尤其是儿童,来自代表性不足的背景的个人，以及医疗补助和Tricare成员。虽然由初级保健医师和NPP发起的eConsults没有显著的诊断或转诊差异，应该继续研究这些不断变化的趋势。
Background: An eConsult is a growing teledermatology tool that has the potential to address health disparities. Trends in teledermatology usage are still being defined in the context of the pandemic, postpandemic recovery, and a growing nonphysician primary care provider population. Objective: The aim was to understand teledermatology utilization trends for asynchronous dermatology eConsults in the geographically expansive state of Texas. Methods: This multicenter retrospective study examined the eConsult tool within a large, nonprofit health system, comparing characteristics of 893 eConsult visits with 27,189 in-person dermatology encounters from January 2022 to March 2023. Results: When comparing the demographics of patients seen through eConsult versus traditional in-person visits, eConsults demonstrated a significantly higher prevalence of pediatric (22.5% vs. 7.6%, p < 0.001), Hispanic/Latino (20.5% vs. 10.4%, p < 0.001), African American (12.5% vs. 6.9%, p < 0.001), Asian (4.6% vs. 2.1%, p < 0.001), and American Indian (1.0% vs. 0.5%, p = 0.049) patients compared with in-person visits. eConsult users came from areas with a lower percentage of bachelor\'s degree holders, reduced average household income, and an increased proportion of Medicaid and Tricare users. Physicians (MD/DO) submitted more eConsult cases than nonphysician providers (NPPs), with comparable diagnostic agreement with teledermatologists and similar recommendation rates for in-person dermatology visits. Conclusions: While the limitation of this study was that it was a descriptive data analysis in a single health care system with limited generalizability, eConsults hold promise to broaden dermatologic access for underserved groups, especially children, individuals from underrepresented backgrounds, and Medicaid and Tricare members. While no significant diagnostic or referral differences were seen for eConsults initiated by primary care physician and NPPs, these changing trends should continue to be examined.
