There are already many experiences and pilots in the community and implemented in some autonomous communities; but teledermatology has entered the daily interaction between primary care and hospital care in Valladolid and expanded to 41 health centers in the province. In the eastern region, it started already in the middle of the pandemic and was developed in 2021 and implemented throughout the region, but activity is lower than in the western region because there are smaller health care problems due to a lack of experts. Even so, it is now common practice to be more flexible in offering help and filtering out injuries and questions about skin spots and concerns in Sacyl consultations.
In the Hortega River, where the project launched last January, the problem of waiting lists due to a lack of experts is even more pressing. The project started in Delicias II and the rural areas of Mayorga and Villalón and will now be expanded to all primary care facilities in the last quarter of the year. In this way, this model of care will be available throughout Valladolid, not only reducing delays, but also decongesting the dermatology services in the hospital and allowing avoidable travel from towns and communities to the care complex. Care becomes more accessible.
System security is guaranteed. And certainly agile. Diagnosis can usually be made within 48 hours. Sometimes immediate, avoiding transfer and reducing medical stress. As Dr. Gonzalo Nieto González, Director of Teledermatology at Río Hortega, explains, “The method is simple but very effective. The patient consults his family doctor or pediatrician about his skin problem, and the doctor sends us an explanatory text explaining its Size, color, characteristics, whether it has grown… whether it is itchy… and send a photo of the specific mobile application of the lesion – magnify it with a dermoscope (a hand-held microscope equipped with a magnifying glass and a light source). All health centers are equipped with one or two A. The dermatologist analyzes the case and “if it’s simple, he treats it and explains it to the family doctor, who then tells the patient. For example, if he or she needs surgical removal, he or she will be called directly to the operating room without a doctor’s consent. Further intermediate consultation is required. “This way, cases are filtered to the hospital if a referral is required,” he added.
Dr. Víctor Muñoz performs outpatient surgery at Delicias II.
Carlos Espeso
The expert emphasizes that this method “we have improved a lot. At first there were many inquiries without photos or not very good. The most useful for us were images. Now the quality is very good. «Normally, 48 hours A diagnosis and prescription can be made within a day, compared to three or four weeks or longer. This is crucial in the most severe cases of melanoma or cancer. It also ensures that the family doctor is on the right track every time. Learn more, learn more. They are treatments that they rarely used before and now they can also ask any questions and we will update them as dermatologists are very knowledgeable about new treatments or therapies that can Provides better results because the number of patients is much larger. The experts are also aware of the latest conferences, articles and conferences. We know them very well. In addition, we meet every three months.
Skin cancer, sunburn, eczema and atopic dermatitis are the most common inquiries
In this way, “we manage to respond to these inquiries in a very short time. Between 100 and 120 consultations are carried out every week via the teleconsultation system. It is ideal for oncological pathology, people with reduced mobility, elderly patients or those who live far away” People are very useful. It’s a way to be more efficient and better triage patients before they’re exposed to the hospital environment,” Nieto said.
He also explained, “The experience worked very well due to the involvement of primary care (teledermatology coordinator) as well as hospital services. There is a very good link between dermatology and primary departments and all the professionals involved in the quarterly meetings Contact can be made directly. “We have very good results in serious illness because they get priority appointments and we can prioritize, or focus on immediately. “
The current quality of the photos and the doctor’s report allow for seamless analysis of stains or lesions
Furthermore, he acknowledges, “teledermatology saves us from breakdown, allowing us to provide immediate care, speed up consultations and address issues ranging from sunburn to cancer, atopic dermatitis or eczema.”
Primary care is pleased with the results. The other side of this coin is provided by Víctor Muñoz, a physician at the Delicias II Health Center who heads the teledermatology program for primary care. He explained that they started the experience with some pilots; but it was relatively rudimentary at first. «We upload patients’ skin problems into their medical history via computer. Using mobile phones is now more flexible and can identify doctor and patient data and send photos. If we have a question, we send it to the dermatologist, an alarm sign we see, whether we need to consult about a mole or we can’t filter it out. Nowadays, the demand is also great because society wants immediate answers and is told to monitor spots and moles and wants to know immediately whether it is good or bad and remove it. “
“We’ve learned a lot and are becoming more and more effective at filtering and analyzing suspicion”
Victor Muñoz
Delicias II Family Physician
Dr. Muñoz admits that during his residency, it was not one of his favorite specialties; but now “this resource encouraged me to study and consult, and I learned a lot about discerning suspicion.”
He also emphasized: “This system proves the effectiveness of well-coordinated healthcare between specialized care and primary care, and we are winners both for patients and professionals. Telemedicine is very useful in some professional areas.
Use a secure mobile phone to take photos on the dermoscope.
Rodrigo Jimenez
process
Primary uses a specific mobile app (left) to take an image of a lesion, spot or mole, magnify it using a dermoscope (above), and upload it to the medical record for consultation. The dermatologist analyzes it and offers treatment or simply orders a biopsy/excision.
The eastern region has a smaller waiting list for the department, starts teledermatology earlier, but has less activity – an average delay of 73 days, compared with 106 days in the western region. While Río Hortega treats more than 100 cases via telemedicine each week, the clinic saw an increase of 95 cases in one year, from September 2022 to the same month in 2023. He pointed out that 44% of them were discharged at that time, “which means that the resolution is very high, so patients can avoid unnecessary visits to the hospital.” A source from the clinic emphasized. It began joining a working group on this in 2020 and developed a referral protocol the following year. An initial pilot project was launched in two health centers in the region and the service will be rolled out to all health centers in the region in June 2021. At the same time, a number of non-face-to-face consultation and training activities were carried out. Specific courses on teledermatology and dermoscopy, basic and advanced levels. The 24 health centers in the region have a person in charge of the project who coordinates such consultations in their teams, all of which have at least one dermoscope, some with 5 (La Victoria) or 4 (Circunvalación), including family doctors and pediatricians.
“It is very useful for oncological pathology, people with limited mobility, the elderly or people who live far away”
Gonzalo Nieto Gonzalez
Río Hortega Dermatologist
Therefore, the area is equipped with 62 dermatoscopes and 45 secure mobile phones to integrate dermatological images. Sacyl also explained, “The application was recently updated to allow the incorporation of images into the patient’s medical history via the professional’s desktop, making the process faster and more efficient. This is an important improvement that will increase the number of family physicians Use of such inquiries.
Reason for consultation
What results will these queries bring? Well, especially in severe cases, melanoma and non-melanoma skin cancers, according to two doctors. “Most commonly, it occurs in older people and is more common in light-skinned people and less common in black people because they have more defenses. Sunburn occurs in childhood and adolescence, but The damage is done over time in adulthood. It’s a very serious thing. The problem is that until the age of 25 or 30, people don’t take care of themselves, they go to the solarium, they sunbathe, and the damage is already done,” Nieto The doctor explained.
Eczema, atopic dermatitis and, in recent years, scabies of “unknown cause” are also common. Especially in the event of an outbreak, it will of course be necessary to treat all cohabitants, for example in care homes or student accommodation. Ringworm is also more common.