Predictors of high-quality patient-submitted skin images among the elderly through a teledermatology platform

Summary: Abstract Body: Teledermatology benefits older adults by reducing costs, saving time, and increasing access to care. Understanding factors influencing its success is key to improving care for this population. Our prospective, observational study followed 138 patients ≥65 years for 1 year. We collected 1,992 images taken by patients. Patients received a text message with a secure, protected link, making it very easy for them to upload images directly from their phones. The study population was diverse, with 88% of the participants aged ≥65 years and 12% aged ≥80 years. Our study population was 53% female, 53% non-Hispanic white, 17% Hispanic, 9% Black, and 14% Asian. Images were rated by clinicians using a Likert scale that assessed: distance, brightness, focus, background, and adequacy for clinical decision-making (0-lowest; 3-highest for a factor, total 14 points max). We conducted a multivariable-regression analysis to identify predictors for patient-submitted photo quality using a generalized estimating equation model by adjusting for sociodemographic characteristics. Additionally, we also performed a subgroup analysis among those aged 80 and older. While the overall image quality was high (mean 12.8/14.0, SD=2.0), those aged > 80 years (vs 65-79, p=0.0079), of White race (vs Black, p=0.022), or those who were not-married (vs married, p=0.020) showed poorer image quality compared to their counterparts. Among those aged >80 years, Asians/Pacific Islanders (vs White, p=0.0098), those with less than high school education (vs bachelor’s degree, p=0.0001), or married (vs not-married, p=0.038) showed poorer photo quality. By factors, age >80 (distance, decision-making), White race (distance, focus, background), and being not-married (distance, brightness, background) were associated with poorer image quality (p<0.05). Improving accessibility, reducing navigation barriers, and focusing on tailored solutions for underperforming groups will be crucial to achieving more equitable dermatology care through teledermatology. Mariana Ramirez¹, Jiyeong Kim¹, Vanessa Nava¹, Sonia Onyeka¹, Joanna Lin¹, Michael Chen¹, Silvina Pugliese¹, Eleni Linos¹, Albert S. Chiou¹ 1. Stanford University School of Medicine, Stanford, CA, United States. Clinical Research: Epidemiology and Observational Research