Teleconsultation on Skin Diseases: The Challenge of Providing Health Care to Isolated Populations in the Amazon Rainforest

This observational study was carried out in the state of Amazonas (Brazil), a huge and remote Rainforest area with only 2.2 inhabitants per square kilometer. This isolation is due to both geographical setting and ethnic-cultural barriers, with the indigenous population representing around 4% (20% of the entire indigenous population of Brazil, 60 ethnic groups and more than 40 languages). The lack of dermatology specialists encourages the few Primary Health Care Doctors (PCD) to apply for asynchronous support on skin disease occurrences through the portal of the Manaus-based Telemedicine and Telehealth Centre (TTC). Subsequently, the TTC counsels the PCD at a distance through his dermatologist-consultants (DC). The performance of such a teleconsultation system was audited by a TTC independent board of experts. They reviewed a 24 months continuous case series by focusing on the quality of PCD applications and DC counseling. The quality of anamnesis, description of physical signs and attached clinical documentation by the PCD was satisfactory in only 56/100, 44/100 and 53/100, respectively. A significantly negative trend (p<0.05) from the first to the second year was also observed. However, the PCD prompted presumptive diagnosis in 87/100, with a 72% of agreement with the DC’s final diagnosis. Indicators of good DC performance were: a) the response to the application within 72 h time occurring in 51/100, with a significantly improving trend (P<0.05); and b) the referrals to the health facilities of the capital of the state being recommended in only 13/100. Teleconsultation represents an opportunity for providing access to isolated populations and minorities. Although DC performance is improving, the high turnover of PCDs and the lack of training in e-health at the undergraduate level result in the poor quality of PCD applications. Thus, instruction in e-health tools should be added to the curriculum of the undergraduate program in medicine.