Disparities in Initial Usage of Direct-to-Patient Teledermatology: A Retrospective Observational Study

While telehealth has potential to enhance patients' access to care, uneven implementation may limit its impact. My VA Images (MVAI), a clinician-gated, patient-facing asynchronous teledermatology application developed by the Department of Veterans Affairs (VA) was piloted at three VA facilities, and then sequentially offered to groups of seven facilities every 3 months for 1 year. We characterized patients who were exposed to and used MVAI and we identified associated characteristics.

We used VA's mobile health and administrative databases to examine MVAI activity and dermatology patient demographics over a 17-month period during 2019 and 2020.

At 11 VA facilities, 494 established dermatology patients were invited to a follow-up visit using MVAI. Invitees were more likely than Non-Invitees to be White and urban, have shorter drive times to specialty care, and have more outpatient and dermatology visits before and after MVAI use. Forty-eight percent of Invitees successfully used MVAI and were most likely to do so in the 8-30 day interval. Successful Users were more likely than Unsuccessful Users to be younger and have a dermatology visit 1 year after MVAI use. Patients requiring multiple attempts before successfully using MVAI were older than initially Successful Users, though younger than Unsuccessful Users.

Not all patients benefited equally during the initial rollout of MVAI. Disparities in VA where other forms of patient-facing telehealth are already common illustrate challenges for health care organizations in equitably implementing direct-to-patient teledermatology. Specific groups may benefit from targeted outreach or support.