Asynchronous teledermatology as an educational and assistive tool in the brazilian public health system: A pilot project

Summary: Abstract Body: This prospective study evaluated the implementation of asynchronous teledermatology in the Brazilian Public Health System to reduce referrals, enhance Primary Care Physician (PCP) education, and assess their dermatological proficiency. Approved by the Ethics Committee, it was conducted in Votorantim, São Paulo, from July to November 2024. Seven PCPs from three Primary Care Units (PCUs) submitted clinical data and photos via a customized platform to three board-certified dermatologists with medical education expertise. Teleconsultations included diagnoses, management recommendations, and educational materials. Dermatologists responded within five business days, compared to several months for traditional referrals. PCPs completed pre- and post-project self-assessment questionnaires on 5-point Likert scales. Thirty-two patients were evaluated, with 27 cases finalized on the platform. Diagnostic concordance between PCPs and teledermatologists showed no significant difference (p=0.123), with discordance being most frequent (53.12%). Of the 32 patients, 29 would have been referred for in-person evaluations pre-teleconsultation. Excluding five incomplete cases, referrals were avoided in 18 of 24 cases (efficiency rate: 75%; 95% CI: 53.3%-90.2%). Six cases required in-person referrals for biopsy (4), dermoscopy (1), or rheumatology (1). PCPs unanimously selected “strongly agree” for learning gains from teleconsultations. Pre- and post-study questionnaires showed significant reductions in referrals (p=0.017) and diagnostic doubts (p=0.014), with improved confidence (p=0.028) and teledermatology perceptions (p=0.045). Limitations included lack of dermoscopes (except in one PCU) and biopsy access in PCUs. Despite this, the project positively impacted patient care and PCP education, aligning with international studies. Though education wasn’t directly measured, improved PCP knowledge during the project may explain the diagnostic outcomes. Further research is needed to evaluate the long-term effects of this model in underserved communities. Thomas Novoa Gomes Jaeger¹, Helena M. Scherlowski Leal David¹ 1. Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil. Minoritized Populations and Health Disparities Research