Reasons for Dermatology Consultations in Nursing Homes and the Estimated Potential of Teledermatology as a Triage Tool
DOI:
https://doi.org/10.2340/actadv.v102.4459Keywords:
elderly care, geriatric dermatology, nursing homes, teledermatology, telemedicineAbstract
Considering the limited availability of dermatologists to perform live consultations in nursing homes, teledermatology could be used as a triage tool for selection of cases for which live consultations are considered to be of added value compared with teledermatology. This prospective, multicentre observational study aimed to determine the reasons for dermatology consultations in nursing homes and the estimated value of teledermatology as a triage tool, including potential predictors. Skin tumours were the most common reason (n = 161/270; 59.6%) for dermatology consultations in nursing homes. Dermatologists estimated that live consultations added value compared with teledermatology in 67.8% of cases (n = 183). Multivariable logistic regression showed that predictors for this added value of live consultations were: consultations because of a skin tumour; consultations during which a diagnostic or treatment procedure was performed; consultations during which a secondary diagnosis was made; and the dermatologist involved. These results indicate that using teledermatology as a triage tool potentially reduces the need for additional live consultations in one-third of patients, whereas live consultations are estimated to have added value over teledermatology in two-thirds of cases. To make optimal use of the limited capacity for live consultations by dermatologists, it could therefore be helpful if elderly care physicians use teledermatology more frequently.
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References
United Nations. World population prospects 2019: highlights. New York: Department of Economic and Social Affairs, Population Division; 2019.
World Health Organization (WHO). Multimorbidity. Geneva: WHO; 2016.
Statistics Netherlands (CBS). Prognose bevolking; kerncijfers (Population forecast; key figures), 2017-2060. 2017. In Dutch. Available from: https://www.cbs.nl/nl-nl/cijfers/detail/83783NED.
National Institute for Public Health and the Environment (RIVM). Aandoeningen, welke aandoeningen hebben we in de toekomst? Trendscenario. 2017. In Dutch. Available from: https://www.vtv2018.nl/aandoeningen.
Kottner J, Rahn Y, Blume-Peytavi U, Lahmann N. Skin care practice in German nursing homes: a German-wide cross-sectional study. J Dtsch Dermatol Ges 2013; 11: 329-336.
https://doi.org/10.1111/ddg.12008 DOI: https://doi.org/10.1111/ddg.12008
Kim EK, Kim HO, Park YM, Park CJ, Yu DS, Lee JY. Prevalence and risk factors of depression in geriatric patients with dermatological diseases. Ann Dermatol 2013; 25: 278-284.
https://doi.org/10.5021/ad.2013.25.3.278 DOI: https://doi.org/10.5021/ad.2013.25.3.278
Hahnel E, Blume-Peytavi U, Trojahn C, Dobos G, Jahnke I, Kanti V, et al. Prevalence and associated factors of skin diseases in aged nursing home residents: a multicentre prevalence study. BMJ Open 2017; 7: e018283.
https://doi.org/10.1136/bmjopen-2017-018283 DOI: https://doi.org/10.1136/bmjopen-2017-018283
Lubeek SFK. Geriatric dermatology: optimising care in frail older adults. Nigmegen: Radboud University Medical Center; 2017.
Roodsari-Rahmati M, Malekzad F. The prevalence of skin diseases among nursing-home patients in North Tehran. Clin Dermatol 2008; 24: 43-46.
Chan S. Prevalence of skin problems in elderly homes residents in Hong Kong. Hong Kong J Dermatol Venereol 2006; 14: 66-70.
Smith DR, Leggat PA. Prevalence of skin disease among the elderly in different clinical environments. Australas J Ageing 2005; 24: 71-76.
https://doi.org/10.1111/j.1741-6612.2005.00084.x DOI: https://doi.org/10.1111/j.1741-6612.2005.00084.x
Akdeniz M, Hahnel E, Ulrich C, Blume-Peytavi U, Kottner J. Prevalence and associated factors of skin cancer in aged nursing home residents: a multicenter prevalence study. PLoS One 2019; 14: e0215379.
https://doi.org/10.1371/journal.pone.0215379 DOI: https://doi.org/10.1371/journal.pone.0215379
Kilic A, Gul U, Aslan E, Soylu S. Dermatological findings in the senior population of nursing homes in Turkey. Arch Gerontol Geriatr 2008; 47: 93-98.
https://doi.org/10.1016/j.archger.2007.07.007 DOI: https://doi.org/10.1016/j.archger.2007.07.007
Lubeek SF, van der Geer ER, van Gelder MM, Koopmans RT, van de Kerkhof PC, Gerritsen MJ. Current dermatologic care in Dutch nursing homes and possible improvements: a nationwide survey. J Am Med Dir Assoc 2015; 16: 714.e711-716.
https://doi.org/10.1016/j.jamda.2015.04.015 DOI: https://doi.org/10.1016/j.jamda.2015.04.015
Lubeek SF, van Gelder MM, van der Geer ER, van de Kerkhof PC, Gerritsen MJ. Skin cancer care in institutionalized elderly in the Netherlands: a nationwide study on the role of nursing home physicians. J Eur Acad Dermatol Venereol 2016; 30: e236-e237.
https://doi.org/10.1111/jdv.13573 DOI: https://doi.org/10.1111/jdv.13573
Lubeek SF, Van Der Geer ER, Van Gelder MM, Van De Kerkhof PC, Gerritsen MJ. Dermatologic care of institutionalized elderly patients: a survey among dermatologists in the Netherlands. Eur J Dermatol 2015; 25: 606-612.
https://doi.org/10.1684/ejd.2015.2657 DOI: https://doi.org/10.1684/ejd.2015.2657
Warshaw EM, Hillman YJ, Greer NL, Hagel EM, MacDonald R, Rutks IR, et al. Teledermatology for diagnosis and management of skin conditions: a systematic review. J Am Acad Dermatol 2011; 64: 759-772.
https://doi.org/10.1016/j.jaad.2010.08.026 DOI: https://doi.org/10.1016/j.jaad.2010.08.026
Lubeek SF, Mommers RJ, van der Geer ER, van de Kerkhof PC, Gerritsen MJ. [Teledermatology within Dutch nursing homes]. Tijdschr Gerontol Geriatr 2016; 47: 117-123 (in Dutch).
https://doi.org/10.1007/s12439-016-0177-1 DOI: https://doi.org/10.1007/s12439-016-0177-1
Schröder AK, Fassmer AM, Allers K, Hoffmann F. Needs and availability of medical specialists' and allied health professionals' visits in German nursing homes: a cross-sectional study of nursing home staff. BMC Health Serv Res 2020; 20: 332.
https://doi.org/10.1186/s12913-020-05169-7 DOI: https://doi.org/10.1186/s12913-020-05169-7
Yong AMY, Leung AJ, Chandran NS. A dermatology health services study of nursing homes in Singapore. Singapore Med J 2020; 61: 661-664.
https://doi.org/10.11622/smedj.2020178 DOI: https://doi.org/10.11622/smedj.2020178
von Stuelpnagel CC, Petersen J, Augustin M, Sommer R. [Dermatologische Versorgung von älteren Menschen mit Psoriasis vor und nach Eintritt in ein Pflegeheim. Eine qualitative Analyse aus Sicht von medizinischen Versorgern]. Dermatologie (Heidelb) 2022; 73: 627-633.
https://doi.org/10.1007/s00105-022-04989-4 DOI: https://doi.org/10.1007/s00105-022-04989-4
Finnane A, Dallest K, Janda M, Soyer HP. Teledermatology for the diagnosis and management of skin cancer: a systematic review. JAMA Dermatol 2017; 153: 319-327.
https://doi.org/10.1001/jamadermatol.2016.4361 DOI: https://doi.org/10.1001/jamadermatol.2016.4361
Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004; 57: 1288-1294.
https://doi.org/10.1016/j.jclinepi.2004.03.012 DOI: https://doi.org/10.1016/j.jclinepi.2004.03.012
Dutch College of General Practitioners (NHG), Nederlandse Vereniging voor Klinische Geriatrie, Orde van Medisch Specialisten. Multidisciplinary Guideline Polypharmacy in elderly. Utrecht: Dutch College of General Practitioners, 2012. In Dutch. Available from: https://www.nhg.org/sites/default/files/content/nhg_org/uploads/polyfarmacie_bij_ouderen.pdf.
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Copyright (c) 2022 Frederik M. Klösters, Marieke E.C. van Winden, Freya R. Angenent, Lambertus Henrikus van Bergen, Marjolein van Steveninck-Wensing, Manon C. Zweers, Ann F.S. Galimont-Collen, Ewald M. Bronkhorst, Raymond T.C.M. Koopmans, Satish F.K. Lubeek
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