A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation
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TELEDERMATOLOGY (D OH, SECTION EDITOR)
A Framework-Driven Systematic Review of the Barriers and Facilitators to Teledermatology Implementation Edwin Dovigi 1
&
Elaine Yuen Ling Kwok 2 & Joseph C. English III 3,4
Accepted: 27 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Telemedicine use in dermatology, termed “teledermatology”, offers a cost-effective model to improve healthcare efficiency and access. Only a minority of dermatology practices has integrated teledermatology into their practice prior to COVID-19. A thorough understanding of the barriers and facilitators may promote teledermatology adoption. Implementation science frameworks offer theoretically driven ways to assess factors affecting teledermatology implementation. This review uses a comprehensive implementation science framework to summarize barriers and facilitators of teledermatology implementation and appraises the quality of existing research. Recent Findings Technological characteristics of teledermatology (e.g., user-friendliness) and factors within the outer setting (e.g., reimbursement and legal considerations) were the most commonly reported barriers. No existing studies use a comprehensive implementation framework to identify factors influencing teledermatology implementation. Many included studies have a risk of bias in at least two of the five study quality indices evaluated. Summary This systematic review is the first study to summarize the existing teledermatology implementation literature into welldefined constructs from a comprehensive implementation science framework. Findings suggest future studies would benefit from the use of an implementation framework to reduce study bias, improve result comprehensiveness, facilitate comparisons across studies, and produce evidence-based resolutions to implementation barriers. Tools, resources, and recommendations to facilitate the use of an implementation framework in future studies are provided. Keywords COVID-19 . Teledermatology . Telemedicine . Dermatology
Introduction Compared to in-person clinic visits, telemedicine reduces geographic and financial barriers to healthcare access, increases convenience, lowers visit costs, and facilitates case triaging
This article is part of the Topical Collection on Teledermatology * Edwin Dovigi [email protected] 1
Rush University Medical Center, 1620 W Harrison St, Chicago, IL 60612, USA
2
Department of Pediatrics, McMaster University, Hamilton, ON, Canada
3
Department of Dermatology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
4
Center for Teledermatology, UPMC North Hills Dermatology, 9000, Brooktree Rd Suite 200, Wexford, PA 15044, USA
and scheduling [1–9]. Telemedicine has become particularly important during the recent COVID-19 pandemic because it facilitates patient monitoring while reducing transmission and exposure risks [10]. For these reasons, many institutions in the USA are urging for expanding telehealth implementation [11–13]. Systema
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