Research Letter
Teledermatology before and after coronavirus
Dimitri Luz Felipe Silva
, Luiz Gameiro, Juliana Yumi Massuda, Renata Ferreira Magalhães, Andrea Fernandes Eloy da Costa França
Corresponding author
Dermatology Discipline, Universidade Estadual de Campinas, Campinas, SP, Brazil
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array:1 [ 0 => array:4 [ "autoresLista" => "Dimitri Luz Felipe Silva, Luiz Gameiro, Juliana Yumi Massuda, Renata Ferreira Magalhães, Andrea Fernandes Eloy da Costa França" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Dimitri Luz Felipe" "apellidos" => "Silva" "email" => array:1 [ 0 => "dimitriluzfs@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Luiz" "apellidos" => "Gameiro" ] 2 => array:2 [ "nombre" => "Juliana Yumi" "apellidos" => "Massuda" ] 3 => array:2 [ "nombre" => "Renata Ferreira" "apellidos" => "Magalhães" ] 4 => array:2 [ "nombre" => "Andrea Fernandes Eloy" "apellidos" => "da Costa França" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Discipline, Universidade Estadual de Campinas, Campinas, SP, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2461 "Ancho" => 2925 "Tamanyo" => 377952 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Opinion of teledermatology users.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic promoted a digital acceleration, resulting in the regulation of the use of telemedicine in Brazil. Faced with the explosion of transmission in Brazil since February 2020, in March the Federal Council of Medicine recognized the possibility of using telemedicine for the purpose of tele-guidance, tele-monitoring, and tele-consultation (CFM 1756/2020). The guidelines for remote consultations were regulated on a temporary basis soon thereafter (Ordinance No. 467 of the Ministry of Health), followed by Law 13,989, signed by the President of the Republic in April.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the worldwide trend, teledermatology was still viewed with reservations in Brazil. The first experiences in this field date from the early 2000s and focused on teletriage and tele-education. Telemedhansen, Telederma, and Anapec were some of the programs in the dermatology field. More recently, a study carried out at the Telemedicine and Telehealth Center in the state of Santa Catarina allowed the diagnostic teletriage of skin cancer through the remote sharing of clinical and dermoscopic images of skin lesions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To date, the adoption of this type of care by dermatologists has been seldom considered. In order to assess the adoption of dermatological tele-consultation in the private sector, the authors conducted a survey with members of the 5<span class="elsevierStyleSup">th</span> dermatological district of the Brazilian Society of Dermatology (Socidedade Brasileira de Dermatologia [SBD] – São Paulo Region), by sending an online form, distributed in June 2020, two months after the beginning of the lockdown. Of the total of 300 dermatologists who received the questionnaire by e-mail, located in 35 cities in the countryside of the state of São Paulo, 84 forms were returned (30% of the members).</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 60% of the respondents were between 41 and 60 years old. Of these, only 7% carried out tele-consultations before the pandemic and regulations.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among those who were not conducting tele-consultations at the time of the study (n = 42), several reasons were cited; the answer “I do not feel it will meet my patient's expectations” was mentioned by 17% of the interviewees. Frustrating previous experiences (12%) and resistance to the use of technology on a daily basis (12%) were other justifications. Financial issues were also mentioned on a smaller scale (smaller payments from health insurance companies, degradation of the profession, lack of demand).</p><p id="par0030" class="elsevierStylePara elsevierViewall">In turn, the performance of telemedicine “at the request of the patient” was the reason for the adoption of this technology by 33% of dermatologists, followed by this being “another source of income” (18%) and “decreased flow of patients in the office” (12%). The enthusiasts of this technology (early adopters) corresponded to 9% of the interviewees.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">When asked about the degree of resolvability of teledermatology on a scale of 1 (no resolution) to 5 (complete resolution), 53% of dermatologists rated it 3 and 33% rated it 4, indicating that 86% considered the technology capable of meeting their demands. Finally, 63% of respondents intended to continue using telemedicine, even after the end of the COVID-19 pandemic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Despite being precipitated by an exceptional situation, the scenario described in the present study reflects a tendency for a paradigm shift in the exercise of the specialty in Brazil, which may now consider teledermatology as a viable option in patient care. Considering that the majority of dermatologists who tested the new technology see it as a satisfactory tool, replicating this method to those who do not yet practice it may be one of the main obstacles in implementing this modality <span class="elsevierStyleItalic">a posteriori</span>. Financial limitations and the establishment of well-defined rules of use also appear to be important factors for its definitive implementation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Several studies in the literature point out the effectiveness of teledermatology, both in the early detection of malignant neoplasms and in the teletriage of tegumentary complaints. Certainly, this connected healthcare model can make a difference in a continental and heterogeneous country such as Brazil.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,7,8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">This survey indicated other uses of teledermatology in the private field and in the scope of offices, in addition to actions aimed at training/matrix support.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contributions</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dimitri Luz Felipe Silva: Design and planning of the study; collection, analysis, and interpretation of data; drafting and/or critical review of the manuscript with relevant intellectual content; approval of the final version.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Luiz Gameiro: Design and planning of the study; collection, analysis, and interpretation of data; drafting and/or critical review of the manuscript with relevant intellectual content; approval of the final version.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Juliana Yumi Massuda: Design and planning of the study; collection, analysis, and interpretation of data.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Renata Ferreira Magalhães: Design and planning of the study; collection, analysis, and interpretation of data; approval of the final version.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Andrea Fernandes Eloy da Costa França: Design and planning of the study; collection, analysis, and interpretation of data; drafting and/or critical review of the manuscript with relevant intellectual content; approval of the final version.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-09-01" "fechaAceptado" => "2020-09-17" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Silva DLF, Gameiro L, Massuda JY, Magalhães RF, França AFEC. Teledermatology before and after coronavirus. An Bras Dermatol. 2021;96:248–50.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology Discipline, Universidade Estadual de Campinas, Campinas, SP, Brazil.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2461 "Ancho" => 2925 "Tamanyo" => 377952 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Opinion of teledermatology users.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 8 | 22 |
| 2024 October | 126 | 77 | 203 |
| 2024 September | 145 | 106 | 251 |
| 2024 August | 197 | 127 | 324 |
| 2024 July | 175 | 125 | 300 |
| 2024 June | 129 | 66 | 195 |
| 2024 May | 131 | 57 | 188 |
| 2024 April | 144 | 81 | 225 |
| 2024 March | 119 | 66 | 185 |
| 2024 February | 138 | 93 | 231 |
| 2024 January | 100 | 52 | 152 |
| 2023 December | 106 | 62 | 168 |
| 2023 November | 183 | 97 | 280 |
| 2023 October | 149 | 95 | 244 |
| 2023 September | 118 | 103 | 221 |
| 2023 August | 156 | 43 | 199 |
| 2023 July | 109 | 57 | 166 |
| 2023 June | 106 | 51 | 157 |
| 2023 May | 86 | 32 | 118 |
| 2023 April | 66 | 27 | 93 |
| 2023 March | 81 | 66 | 147 |
| 2023 February | 77 | 39 | 116 |
| 2023 January | 68 | 44 | 112 |
| 2022 December | 81 | 38 | 119 |
| 2022 November | 99 | 68 | 167 |
| 2022 October | 178 | 65 | 243 |
| 2022 September | 87 | 90 | 177 |
| 2022 August | 79 | 61 | 140 |
| 2022 July | 76 | 69 | 145 |
| 2022 June | 93 | 71 | 164 |
| 2022 May | 70 | 69 | 139 |
| 2022 April | 92 | 68 | 160 |
| 2022 March | 68 | 89 | 157 |
| 2022 February | 49 | 39 | 88 |
| 2022 January | 95 | 98 | 193 |
| 2021 December | 94 | 57 | 151 |
| 2021 November | 75 | 57 | 132 |
| 2021 October | 49 | 89 | 138 |
| 2021 September | 51 | 74 | 125 |
| 2021 August | 50 | 64 | 114 |
| 2021 July | 63 | 70 | 133 |
| 2021 June | 87 | 72 | 159 |
| 2021 May | 149 | 104 | 253 |
| 2021 April | 373 | 323 | 696 |
| 2021 March | 70 | 44 | 114 |
| 2021 February | 8 | 9 | 17 |
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