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Enhancing Dermatological Services in Health Care

Dermatology is one of the branches of medicine concerned with the diagnosis and treatment of skin disorders. There is strong demand for dermatology services from primary care, with many patients self-treating or consulting their general physician.  The majority of skin consultations with general physicians concern the 10 most common skin conditions: which are skin lesions, eczema, psoriasis, acne, contact dermatitis, infectious skin disorders and viral warts.  Dermatology has a comparatively high number of referrals to specialist care, particularly for diagnosis.   Although mortality rates from skin conditions are comparatively low, skin cancer rates are rising, and half of all specialist activity now relates to the diagnosis and management of skin lesions.   Skin diseases can occur at all ages, but some skin conditions are more common in certain age groups, such as: high rates of eczema in children; high rates of acne in teenagers; and increasing rates of skin cancer in adults. An increasing elderly population is likely to increase demand for dermatology services. There is likely to be a significant proportion of the population who will demand to see a specialist for an accurate diagnosis and treatment plan

In order to make services more efficient and fast enhancements ought to be done. Some of the enhancements that have been done include self-skin examination and tele- dermatology .This enhancements have been used minimally but over time specialists are developing interests.

 Firstly, it requires a good rapport between the patient and the dermatologist .It has been shown that poor patient satisfaction can lead to poor adherence to treatment with consequently poor health outcomes. In order to improve the quality of care perceived by the patient, it is important to understand the main factors that could improve the quality of the customers. In addition, improving service delivery increasing the involvement of the patients in the delivery of health care services is essential. This has been made possible through creation of websites in which the patients can access their files. It has made work easier for the physicians as well as the patients in critical areas such as booking of appointments. Through this patients are able to gain better knowledge concerning the disease by using the internet.

Skin –self examination is an intervention in dermatology that includes the provision of a whole body digital photography book depicting the entire skin surface .There are some medical factors associated with  this intervention include having a history of cancer and a greater sensitivity to the sun. Though yet unproven ,it is potentially useful in reducing incident and invasive diagnoses of melanoma .A recent study done on skin –self examination among Latinos who are prone to melanoma disease because of their skin tone, show that it was effective .Through skin –self examination they were able to perceive the benefit of early detection of the disease. It is with this advancement in dermatological services that; Latinos are more knowledgeable about melanoma, have a better perception about risk of developing melanoma. They are able to perform the skin self examination on themselves efficiently. Being able to perceive the norms for checking the ski n and seeking care from a practitioner has been an added advantage to the Latinos.

Dermatological services can be enhanced through the use of teledermatology. It is a subspecialty of dermatology and is becoming a popular application of telemedicine. Telecommunication technologies are used to transfer medical information over varying distances through audio and visual communication .Teledermatology is can be applied in treatment ,diagnoses and consultation. It is differentiated in two common ways which are: life synchronous ,which involves the doctor and patient communicating directly ,or store and forward methods ,in which the patient and doctor provide and assess the medical information independently it was used to try to achieve different aims :as a triage / referral management tool ,as an education and communication tool , as a substitute to an outpatient appointment (particularly for patients in rural or remote areas).

Consultation is a process is done through when a patient ailing form a certain skin condition gets to contact a dermatologist .This is mostly done through telecommunication; where a request for treatment and proper diagnosis is done. The mobile applications which enable teledermatology are of importance and help in making dermatological services efficient and easily accessible.

Diagnosis done through telecommunication devices can be an intricate procedure especially if it is done in the absence of a qualified health worker. Misdiagnosis can be done if patient is allowed to go through the entire procedure without accurate guidance. Nonetheless, it operates as an important tool in triage, by directing individuals to the suitable health care provider. This can be a tool of value in enhancing dermatological services.

Special referral is a crucial application of teledermatology. Practitioners  consult with specialists for their view, this helps them to be accurate in whatever in treating the patients. The specialist can help in providing beneficial management opinions, and other vital procedures.

The advantages of teledermatology include; reduced tariff per teledermatology case compared to face-to-face outpatient referral.  Good use of limited consultant resources; with no clinic room or nurse overhead costs, and little secretarial input required. Rapid access to consultant dermatologist advice, compared to the average wait for a routine new outpatient appointment of a couple of weeks. Providing dermatological care closer to home and addressing the burden of skin disease in the community. Patients with non-melanoma skin cancer can be triaged directly onto a skin surgery list, with significant tariff savings and more efficient patient pathways, especially for elderly patients travelling long distances. Rapid dermatology educational feedback, to improve dermatological knowledge in general practice.

Another way of enhancing dermatological services is through telehomecare.It is the use of telecommunication devices to follow up on patients who were are suffering from chronic skin conditions .Skin conditions such as crural ulcers require frequent follow up appointments .Patients with such diseases are able to receive the care they want .Tele-dermatology helps to reduce time as well as cost required in such frequent follow –up appointments.

Technology is also applicable in treatment procedures .It helps make the treatment to be fast and efficient .It has been efficient in dermoscopy,which is a technique used by dermatologists  to examine their patients .Teledermoscopy is made possible since the skin specialists are able to receive dermoscopic lesion images through electronic transmission in order to examine the lesions . I t is also helpful in identifying skin conditions such as malignant skin lesions or melanoma. The specialist’s job is a made easier as they are able to analyze the severity of the lesions. This goes a long way in improving dermatological services.

Besides the interventions that have been discussed above, the use of mobile diagnosis through apps is another method that has proved its efficacy in dermatology .These apps are defined as mHealth apps, whose aim is to improve the health outcomes and the delivery of health care services .They are also known to enable health research .In dermatology the apps are essential as they improve patient self management and health monitoring, also improve communication with the skin specialists. With specificity to skin cancer, there are apps which provide information and behavioral motivation and instructions on sun protection, skin cancer prevention and early detection; some go to the extent of offering the option to submit photographs of suspicious skin lesions for diagnostic assessment.

In addition, enhancing permeability barrier for atopic eczema is another crucial intervention. Improving the permeability of the barrier function not only prevents atopic eczema, it also delays the relapse of this diseases. The epidermal permeability barrier plays an important role in regulating the cutaneous inflammation .Atopic eczema is a result  of an abnormality in the permeability barrier function .Hence if  the permeability barrier is improve it will help in treatment of the skin disease. Application of barrier enhancing products with glucocorticoids can increase the therapeutic efficiency and reduce the adverse effects of glucocorticoids in atopic eczema .The utilization of permeability barrier enhancing products alone or in combination with glucocorticoids could be a valuable approach in treatment of atopic eczema. This approach has proved to be effective in treating skin disorders such as atopic dermatitis. However this approach is still not valued by many dermatologists. Encouraging use of this treatment can help in the enhancement of dermatological services.

Increasing the number of dermatologist to match with the number of patients can be a big step towards enhancing the dermatological services. Studies that have been done show an increase in demand for dermatologists.

Self-care among patients suffering from skin disorders, such as warts, can self treat themselves. This will possibly reduce the number of primary acre referrals. Services to support self-care for patients with skin conditions also include patient support organizations, which often rely on donations from individuals and pharmaceutical company’s ( le site ) .Although evidence on the effectiveness of self-help organizations is not available, their role is valued by patients and dermatologists.

Many patients suffering from a skin disease (particularly those with chronic conditions) also suffer from pronounced psychological distress.  Overall, mental health provision for dermatology patients is poor and minimum standards to support patients with psycho dermatological distress are often not met.  Consultants are often time-limited and see only the skin condition in front of them, rather than the patient’s holistic needs; few ask the patient how the condition affects their daily lives. There is concern that general practitioners lack understanding of the psychosocial impacts of chronic skin conditions on patients. Increasing the amount of time consultants have available for patients is to improve the efficiency of the work flow, particularly through outpatient clinics. This will help the consultants to understand the patient’s problem better.

The majority of specialist dermatology services are delivered through the outpatient model, with variable links to other specialties. There is variation in specialist practice, and further audits of service delivery are needed to understand the extent of the issue.  The majority of specialist dermatology services delivered through skin lesion and skin cancer services appear to be working well, but are becoming an increasing proportion of specialist activity.  Referrals include many that do not need to be treated, although there is a risk that reducing referrals may miss patients with skin cancer due to variation in diagnostic quality in primary care.   People with chronic skin conditions have difficulty re-accessing services.   There is limited focus on addressing inequalities in access to dermatological services. The issue of not being able to re-access dermatological services should be addressed so as to make service delivery in dermatology more accessible.

 Development of a dialogue between primary and secondary care and a cohesive approach to the development of dermatology services is valuable .It cannot be compared to shifting services into the community. There is also concern that commissioners lack a basic understanding of the patient need for dermatology services and often do not utilize evidence-based approaches to redesigning dermatology services. Health commissioners should be more involved in bettering the dermatological services so as to ensure unnecessary mishaps in the service delivery in dermatology.

Developing an ‘attending’ model- The option of running larger clinics where the specialty doctors ( geoallo dentiste ) see patients and the consultant supervises and acts as an ‘attending’ to the service was discussed at the workshop; this model means the consultant would see only a couple of very complex cases in each clinic.

Developing skin lesion centers, pulling all skin lesion referrals together in one service in a specialist centre could improve efficiencies and facilitate effective audit and clinical governance. The consultant undertaking diagnosis and treatment only other health care workers could be trained to do the same job. Direct patient access for patients with severe chronic conditions will help in enhancing dermatological services: this is because the patients will not have to go through someone else to in order to get to the specialist. The commissioners in charge of health services, the health staff (in particular the dermatologists), nongovernmental organization should make sure efficient service delivery in dermatology by working together for the good of the patient.