To the Editor: Virtual care has several benefits: care efficiency, improved decentralized access, cost-effectiveness, and reduced travel requirements.1 The inadequacy of virtual care options can result in increased system, travel costs, and inequitable access for patients outside urban areas.2 Due to the heavy visual component of skin conditions, many diagnoses of simple inflammatory diseases can be made with a visual inspection, making dermatology uniquely suitable for virtual care with images.3 Dermatologists can use patients’ clinical histories and pictures of the skin to diagnose skin disorders remotely and recommend appropriate treatments. Virtual dermatology visits can potentially treat certain skin conditions while improving access to dermatology care in both remote and urban areas while ensuring timely care.1,3 As virtual care continues to be integrated into provincial healthcare systems across Canada, we deemed it valuable to explore the perspectives of patients who have received virtual dermatology care. This study aims to fill a knowledge gap regarding patient attitudes toward virtual dermatology to improve patient satisfaction and advocate for continued government funding for virtual dermatology services in Canada.
All patients of DermCafé, a Canadian virtual dermatology clinic serving patients from Ontario, British Columbia and Alberta, were recruited to complete an anonymized online survey through email, social media, and patient newsletters. Survey responses were collected between 2nd and 23rd August of 2021. Survey completion was voluntary and incentivized with a L’Oréal gift set random draw. We retrieved all study data using a detailed questionnaire developed by the research team and using current literature.1 Statistical analysis was performed using Microsoft Excel. Duplicate survey answers were removed. Descriptive statistics for categorical variables were represented by percentages, while continuous variables were expressed with the mean and standard deviation. Due to the nature of the survey data collection, a response rate could not be calculated.
Before their virtual dermatology experience, 413 (34.2%) respondents had never accessed a dermatologist before and a total of 458 (37.9%) respondents reported waiting more than 6 months to access a dermatologist in person (Table I). Overall, there was a high level of agreement that the virtual appointment was the quickest respondents had ever accessed a dermatologist (Table II). This timely virtual visit with DermCafé did not seem to impact the quality of care received, as most patients reported having sufficient time to address their concerns and felt comfortable addressing all their dermatologic concerns virtually. Additionally, most patients said that they would either use virtual dermatology again or recommend it to others. Participants also agreed that virtual dermatology care saves travel time and associated costs and reduces wait times. Patients also found virtual dermatologic care more convenient when compared to in-person care.
Table I.
Demographics and characteristics of adult patients (N = 1207)
| Characteristic | Value, n (%) |
|---|---|
| Gender | |
| Male | 221 (18.3) |
| Female | 975 (80.8) |
| Nonbinary/nonconforming | 4 (0.3) |
| Prefer not to say | 7 (0.6) |
| Age | |
| 18-29 | 580 (48.1) |
| 30-44 | 449 (37.2) |
| 45-60 | 131 (10.9) |
| 60+ | 47 (3.9) |
| Province of residence | |
| Ontario | 1162 (96.3) |
| British Columbia | 38 (3.1) |
| Alberta | 5 (0.4) |
| Nova Scotia | 1 (0.1) |
| New Brunswick | 1 (0.1) |
| Region of residence | |
| Large population urban centre (population >100,000) | 921 (76.3) |
| Medium population urban centre (population 30,000-99,999) | 160 (13.2) |
| Small population urban centre (population 1000-29,999) | 93 (7.7) |
| Rural population (population <1000) | 33 (2.7) |
| Race | |
| Asian – East | 148 (12.3) |
| Asian – South | 187 (15.5) |
| Asian – South East | 57 (4.7) |
| Black – African | 28 (2.3) |
| Black – Caribbean | 15 (1.2) |
| Black – North American | 7 (0.6) |
| First Nations American | 3 (0.2) |
| Métis | 5 (0.4) |
| Indigenous/aboriginal and other | 11 (0.9) |
| Indian – Caribbean | 5 (0.4) |
| Latin American | 46 (3.8) |
| Middle Eastern | 38 (3.1) |
| White – European | 156 (12.9) |
| White – North American | 350 (30) |
| Mixed heritage | 13 (1.1) |
| Do not know/prefer not to answer | 31 (2.6) |
| White – European and North American | 43 (3.6) |
| Asian – East and South East | 5 (0.4) |
| Black – Caribbean and North American | 3 (0.2) |
| Other – Multiple selected/mixed | 47 (3.9) |
| Other (specified) | 9 (0.7) |
| Education level | |
| Elementary school | 12 (1) |
| Secondary school | 142 (11.8) |
| College | 235 (19.4) |
| University | 554 (45.9) |
| Masters | 203 (16.8) |
| Doctorate | 50 (4.1) |
| No formal education | 2 (0.2) |
| Other education | 9 (0.7) |
| Dermatologic condition assessed | |
| Acne/rosacea | 606 (50.2) |
| Eczema/dermatitis | 130 (10.8) |
| Hair loss | 51 (4.2) |
| Skin lesion or spot | 46 (3.8) |
| Psoriasis | 38 (3.1) |
| Seborrheic dermatitis | 35 (2.9) |
| Melasma | 26 (2.2) |
| Keratosis pilaris | 18 (1.5) |
| Contact dermatitis | 16 (1.3) |
| Photoaging/skincare concern | 13 (1.1) |
| Other skin rash | 59 (4.9) |
| Other facial rash (eg, perioral dermatitis) | 40 (3.3) |
| Other skin concern not mentioned above | 129 (10.7) |
| Average wait time to see a dermatologist prior to study | |
| Never accessed a dermatologist before | 413 (34.2) |
| Less than 4 wk | 51 (4.2) |
| 1-2 mo | 83 (6.9) |
| 2-6 mo | 202 (16.7) |
| 6 mo-1 y | 336 (27.8) |
| More than 1 y | 122 (10.1) |
Table II.
Patient attitudes toward virtual dermatology (N = 1207∗) rated on a likert score from 1 (strongly disagree) to 5 (strongly agree)
| Strongly agree (5) |
Agree (4) |
Neutral (3) |
Disagree (2) |
Strongly disagree (1) |
Mean | SD | |
|---|---|---|---|---|---|---|---|
| n (%) | |||||||
| Accessibility | |||||||
| I have never been able to access a Dermatologist visit as quick as I did on DermCafé | 761 (63.0) | 259 (21.4) | 134 (11.1) | 14 (1.1) | 39 (3.2) | 4.40 | 0.96 |
| My DermCafé virtual appointment was user-friendly | 725 (60.0) | 413 (34.2) | 49 (4.1) | 5 (0.4) | 15 (1.2) | 4.51 | 0.71 |
| Virtual dermatology care was appropriate to the health concern that I had | 724 (60.0) | 341 (28.2) | 82 (6.8) | 28 (2.3) | 32 (2.7) | 4.41 | 0.91 |
| Perceived quality of care | |||||||
| I felt that there was enough time to address my concerns | 608 (50.4) | 423 (35.0) | 109 (9.0) | 41 (3.4) | 26 (2.2) | 4.28 | 0.92 |
| I felt comfortable discussing and addressing all of my concerns | 730 (60.5) | 391 (32.4) | 55 (4.6) | 15 (1.2) | 16 (1.3) | 4.50 | 0.76 |
| Before my DermCafé visit, I believed that certain skin concerns (eg, acne, rosacea) could be diagnosed and treated by a Dermatologist examining a photo | 275 (22.8) | 433 (35.9) | 329 (27.3) | 141 (11.7) | 29 (2.4) | 3.65 | 1.03 |
| I felt that my privacy was respected during my virtual appointment at DermCafé | 754 (62.5) | 393 (32.6) | 45 (3.7) | 2 (0.2) | 13 (1.1) | 4.55 | 0.68 |
| I trusted the assessment that the DermCafé Dermatologist made based on the photos and information I provided | 656 (54.4) | 440 (36.4) | 75 (6.2) | 19 (1.6) | 17 (1.4) | 4.41 | 0.79 |
| My DermCafé Dermatologist was able to diagnose my skin concern based on my pre-submitted photos | 692 (57.3) | 373 (30.9) | 86 (7.1) | 24 (2.0) | 32 (2.7) | 4.38 | 0.90 |
| After my experience at DermCafé, I would use virtual dermatology clinics again | 804 (66.6) | 303 (25.1) | 58 (4.8) | 15 (1.2) | 27 (2.2) | 4.53 | 0.83 |
| After my experience at DermCafé, I would recommend virtual dermatology to a friend or family member | 821 (68.0) | 285 (23.6) | 60 (5.0) | 15 (1.2) | 26 (2.2) | 4.54 | 0.83 |
| Comparison to in-person care | |||||||
| I felt more engaged during my DermCafé visit than during an in-person Doctor’s visit | 326 (27.0) | 249 (20.6) | 471 (39.0) | 122 (10.1) | 39 (3.2) | 3.58 | 1.09 |
| I prefer seeing my dermatologist in person rather than via virtual clinic | 165 (13.7) | 191 (15.8) | 476 (39.4) | 236 (19.6) | 139 (11.5) | 3.00 | 1.17 |
| Virtual dermatology care is more convenient than in-person care | 726 (60.1) | 287 (23.8) | 149 (12.3) | 26 (2.2) | 19 (1.6) | 4.39 | 0.90 |
| I prefer having prescriptions delivered for free to my address within 1-2 d, instead of picking my prescriptions up in-person | 405 (33.6) | 295 (24.4) | 340 (28.2) | 140 (11.6) | 27 (2.2) | 3.75 | 1.11 |
| Convenience | |||||||
| Virtual dermatology care saves travel time and associated costs | 911 (75.5) | 238 (19.7) | 38 (3.1) | 6 (0.5) | 14 (1.2) | 4.68 | 0.67 |
| Virtual dermatology care reduces wait times | 875 (72.5) | 256 (21.2) | 56 (4.6) | 6 (0.5) | 14 (1.2) | 4.63 | 0.70 |
| A virtual clinic makes me less dependent on others | 479 (39.7) | 362 (30.0) | 288 (23.9) | 60 (5.0) | 18 (1.5) | 4.01 | 0.98 |
| If wait-times were the same, I would choose a virtual dermatology appointment again for reasons relating to reduced travel time/associated costs, convenience or other reasons | 547 (45.8) | 351 (29.4) | 178 (14.9) | 86 (7.2) | 32 (2.7) | 4.08† | 1.06 |
| Virtual care funding | |||||||
| I believe that virtual dermatology care needs to be publicly funded by the government | 806 (66.7) | 290 (24.0) | 91 (7.5) | 5 (0.4) | 15 (1.2) | 4.55 | 0.76 |
| If the government were to remove public funding for virtual dermatology care, this would severely and negatively impact my skin health | 529 (43.8) | 361 (29.9) | 227 (18.8) | 60 (5.0) | 30 (2.5) | 4.08 | 1.02 |
The total number of survey participants was 1207 unless otherwise specified.
The mean for this question is based on an n = 1194 due to multiple patients choosing to provide other answers for why they would choose a virtual dermatology appointment.
These insights show that virtual dermatology care for minor inflammatory conditions can offer patients an expeditious alternative to in-person appointments while maintaining patient satisfaction. We hope that our study results encourage the Ontario government to continue funding virtual dermatology beyond the COVID-19 pandemic. By offering virtual dermatology care more broadly, Canada can work toward increasing the number of patients seen while reducing overall wait times.
Conflicts of interest
Annie Liu is the Co-Founder of DermCafé, the virtual dermatology clinic, whose patients we surveyed for the study.
Footnotes
Drs Music and Elsawi are cofirst authors.
Funding sources: L’Oreal for survey incentive prizes.
IRB approval status: Not applicable.
Patient consent: Consent for the publication of all patient medical information was provided by the authors at the time of article submission to the journal stating that all patients gave consent for their medical information to be published in print and online and with the understanding that this information may be publicly available.
Research ethics: Research ethics approval was not sought as this study is a quality improvement initiative.
References
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