Study Highlights Preferences in Teledermatology for Patients with Psoriasis

New findings suggest that although standard-of-care is preferred over teledermatology among those with psoriasis, attributes of teledermatology acknowledged by such patients include acknowledgment of concerns and prompt consultation at the time of acute flare-ups.1

These data were the result of a recent analysis authored Patrick Reinders, MSc, from the Institute for Health Services Research in Dermatology and Nursing (IVDP) at the University Medical Center Hamburg-Eppendorf (UKE) in Germany.

Reingers et al. noted that despite teledermatology’s potential for dermatology, it remains relatively under-implemented. They cited recent research from Germany assessing telemedicine preferences within primary care settings, adding that the results of this analysis were not apparent in their applicability to chronic skin conditions such as psoriasis.2

“To address these research gaps, we developed a [discrete choice experiment] to identify the preferred characteristics of teledermatological care among patients with psoriasis,” Reinders and colleagues wrote.1 “In addition, we aimed to examine how these preferences interact with demographic, socioeconomic, geographical, disease-specific and care-specific parameters.”

The investigative team carried out a discrete choice experiment (DCE), during which participants are asked to determine their preferred choice from a set of hypothetical care scenarios. There are typically a set of 2 or 3 at a time.

Each of these scenarios is characterized by specific elements, such as waiting times, which are presented at predetermined levels. Those taking part in the DCE demonstrate how they prioritize various elements of care by their choices in this selection, helping to point out which features of care delivery on which they place the most value.

The team sought to ensure that the DCE reflected patient-relevant and realistic scenarios, using consultations with dermatologists, a comprehensive review of existing research, and analyses of focus group transcripts from a previous analysis looking at digital health technologies such as live-interactive (LI) and store-and-forward (S&F) teledermatology.

Using this foundational work, the investigators identified 2 teledermatology use cases that they deemed to be the most relevant to patients: follow-up appointments, supported by current clinical guidelines, and urgent care scenarios, during which patients would implement teledermatology to avoid delays. Both of these scenarios involved the use of a description regarding the manner in which electronic prescriptions function within the digital care model.

Following the research team's literature review and collection of focus group insights, a preliminary list was drafted of attributes for the DCE. They sought to validate and refine these, carrying out semi-structured interviews with 6 patients, 2 dermatologists who were known to have teledermatology experience, and 2 entrepreneurs in the digital health space.

These interviews followed guidelines recommended by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Presentation of the final list of attributes in the DCE included the mode of teledermatology (LI versus S&F), whether the treating clinician was shown to be familiar to a patient, the extent to which a patient felt that concerns were acknowledged, and the ability to make inquiries.

Those taking part in the study as subjects were randomly assigned to consider one of 2 possible scenarios: consultation for an acute flare-up or a follow-up visit. The investigative team evaluated their data using conditional logit models.

Overall, there were 221 patients living with psoriasis who took part in the analysis, with an average age of 58.9 years and 39.8% reported as female. There was a notable preference the investigators identified among these subjects for traditional in-person care across both of the clinical scenarios:

• Acute consultation: β = −0.86, P = .001
• Follow-up consultation: β = −1.24, P = .001

Several elements were shown by the team to have increased the likelihood of the teledermatology choice among patients. These included having the opportunity to submit questions (acute: β = 0.35, P < 0.001; follow-up: β = 0.52, P < .001), receiving care from a clinician the patient already knew (acute: β = 0.49, P < .001; follow-up: β = 0.51, P < .001), reporting that one's concerns were strongly acknowledged (acute: β = 0.48, P < .001; follow-up: β = 0.50, P < .001). In acute care scenarios, the investigators determined rapid feedback—defined in the analysis as being given a response within 24 hours—was especially shown to be valued (β = 0.51, P < .001).

A lack of significant preference was highlighted by the investigative team between the 2 teledermatology delivery modes they had described (LI vs. S&F) in either the acute or follow-up settings. Those who expressed fewer concerns related to privacy and reported having higher levels of comfort with technology were shown by the team to be more inclined to prefer teledermatology.

In the acute care cohort, the investigators determined that longer current waiting times positively influenced a teledermatology choice, while in the follow-up cohort, regular blood testing requirements raised its appeal.

“The discrete choice experiment explored patient preferences that could improve teledermatology adoption in Germany,” they concluded.1 “While standard-of-care was generally preferred, preference for teledermatology improved when patients were consulted by their known physician, had their concerns acknowledged and could ask questions.”

References

1. Reinders P, Augustin M, Stephan B, Otten M. Understanding patient priorities in teledermatology for psoriasis: A discrete choice experiment. J Eur Acad Dermatol Venereol. 2025; 00: 1–12. https://doi.org/10.1111/jdv.20701.

2. Bridges JFP, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA, et al. Conjoint analysis applications in health—a checklist: a report of the ISPOR good research practices for conjoint analysis task force. Value Health. 2011; 14: 403–413.