Date Published: September 24, 2018
Publisher: Public Library of Science
Author(s): Kevin Zarca, Nathanael Charrier, Emmanuel Mahé, Fabien Guibal, Béatrice Carton, François Moreau, Isabelle Durand-Zaleski, Valerio De Vita.
The prevalence of skin diseases among prisoners is higher than in the general population. Diagnosing and treating these lesions require a dermatologic advice. A tele-expertise network in dermatology for prisoners including 8 health facilities in prison and 2 hospital dermatological departments was developed to improve access to dermatologists’ expertise in correctional facilities. Our objective was to evaluate the effectiveness and costs of tele-expertise in dermatology for prisoners.
We carried out a retrospective cohort study on data collected by the information system of the tele-expertise network. We used the MAST (Model for ASsessment of Telemedicine) model to perform a multidimensional assessment including the proportion of patients with a completed treatment plan for the skin lesions, the proportion of technical problems, the quality of the pictures, the investment and operating costs and the satisfaction of the professionals.
Mean patient age was 34.2 years with 90% men. 511 requests for 450 patients were initiated. The delay from the connection to the tele-expertise software to the validation of the request was inferior to 7 min for 50% of the requests and inferior to 30 min for 85% of the requests. Overall, with tele-expertise, 82% of the patients had a completed treatment plan for the skin lesions, with 2.9% of all patients requiring a later face-to-face appointment or hospitalization, to be compared to a proportion of 35% of patients with a completed treatment plan when tele-expertise was not available. The most frequent lesions were acnea (22%) and atopic dermatitis (18%). The mean cost for one completed treatment plan was €184 by tele-expertise and €315 without tele-expertise. Tele-expertise was well accepted among physicians with all responders (n = 9) willing to continue using it.
Tele-expertise is a dominant intervention in comparison to a face-to face consultation taking into account the cost of transportation and the proportion of canceled appointments and is acceptable for physicians.
The prison population can be considered as a vulnerable group since disadvantaged social groups are overrepresented. Upon entrance, prisoners are in a weakened state of health due to poor access and utilization of health services and present a high prevalence of risky behavior . In addition, there is a gradual aging of the prison population (the proportion of prisoners over age 60 increased from 1.0% in 1980 to 3.7% in 2014), which can lead to a growing number of chronic conditions to be managed in prisons. Few articles have estimated the prevalence of skin diseases in the prison population , but previous studies in France confirmed a high need for dermatological consultations in prison [3,4].
Tele-expertise in dermatology for prisoners allowed a higher proportion of patients with a completed treatment plan for the skin lesions (82% vs. 35%). For a total of 511 annual requests for 450 patients from 8 prison health centers and with 2 dermatological centers carrying out the analysis, the cost of one completed treatment plan was €184. We found that tele-expertise was therefore a dominant intervention in comparison to the cost of an appointment taking into account the cost of transportation and the proportion of canceled appointment (€315). Furthermore the physicians using tele-expertise seemed satisfied with the new workflow.
Tele-expertise for diagnosis of dermatologic lesions among prisoners was found to be effective, increasing the proportion of patients with a completed treatment plan and the overall satisfaction of the requesting physicians at a cost far lower than a dermatologists’ consultation in a hospital.