Implementation of Direct-to-Patient Mobile Teledermatology in VA.

Implementation of Direct-to-Patient Mobile Teledermatology in VA.

Publication date: Jan 22, 2024

Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. We evaluated Department of Veterans Affairs’ (VA’s) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app’s implementation using qualitative and quantitative data consisting of encounter data from VA’s corporate data warehouse; app usage from VA’s Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. Implementation policies and practices included VA’s vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. Considerable heterogeneity existed in implementing mobile teledermatology, despite VA’s common mission, integrated healthcare system, and stakeholders’ broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. NCT03241589.

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Concepts Keywords
Competing asynchronous care
Corporate dermatology
Healthcare direct-to-consumer teledermatology
Monthly implementation science
Nct03241589 mobile teledermatology
telemedicine

Semantics

Type Source Name
disease VO effective
disease VO effectiveness
disease VO monthly
disease IDO facility
drug DRUGBANK Etoperidone
disease MESH COVID-19 pandemic
disease IDO quality
disease IDO process
drug DRUGBANK Methylphenidate
disease VO USA
disease VO organization
disease VO population
disease IDO history
disease VO document
disease IDO intervention
disease VO device
drug DRUGBANK Coenzyme M
disease VO time
pathway REACTOME Release
disease VO biweekly
disease VO protocol
disease VO Thing
disease IDO site
drug DRUGBANK Bismuth subgallate
drug DRUGBANK Trestolone
drug DRUGBANK Aminosalicylic Acid
drug DRUGBANK Spinosad
drug DRUGBANK Tretamine
disease VO report
disease MESH acne
disease MESH psoriasis
disease MESH skin disease

Original Article

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