Giavina-Bianchi 2020 — Teledermatology reduces referrals and waiting times (São Paulo, 30,976 patients)
Citation
Giavina-Bianchi M, Santos AP, Cordioli E. Teledermatology reduces dermatology referrals and improves access to specialists. eClinicalMedicine. 2020 Nov 21;29–30:100641. DOI: 10.1016/j.eclinm.2020.100641. PMID 33437950.
Study design and population
Cross-sectional retrospective real-world implementation study. 30,976 individuals with 55,624 skin lesions triaged via store-and-forward teledermatology; São Paulo municipal public-health system; July 2017–July 2018.
Reported metrics
- 53 % of all triaged cases managed entirely within primary care (avoided specialist referral)
- 43 % referred to in-person dermatologist; 4 % referred directly to biopsy
- 78 % reduction in mean waiting time for in-person dermatologist appointment — from 6.7 months to 1.5 months
Surrogate-to-outcome linkage
Largest contemporary real-world quantification of waiting-time reduction and referral-filtering surrogates in a public-health setting. The 78 % waiting-time reduction maps directly onto the Conic 2018 surgical-delay → mortality-hazard gradient for suspected malignancies (4 % direct-biopsy route). Anchors the quantitative care-pathway claim in Domain 3.
CRIT1–7 appraisal
| Criterion | Score | Justification |
|---|---|---|
| CRIT1 Relevance | 3 | Direct — teledermatology referral-filtering and waiting-time surrogates. |
| CRIT2 Methodology | 2 | Very large retrospective real-world cohort; municipal public-health system. |
| CRIT3 Reporting | 2 | Point estimates reported; 95 % CIs not all stated. |
| CRIT4 Applicability | 2 | Brazil public-health context; partial EU-transferability. |
| CRIT5 Evidence weight | 1 | Retrospective cross-sectional (highest-quality real-world evidence at this scale). |
| CRIT6 Risk of bias | 2 | Retrospective; single health system; no clinical outcome follow-up; selection bias in teledermatology uptake. |
| CRIT7 Contribution | 3 | Core quantitative anchor — most-cited modern number for teledermatology waiting-time reduction. |
Aggregate: strong.
Limitations and notes
Brazil public-system context; no patient-outcome follow-up; selection bias in referral uptake.
Strength as anchor
Strong — the canonical modern quantitative anchor for waiting-time reduction in teledermatology. Used widely in HTA reports including NICE / NIHR evaluations.