Teledermatological monitoring of leg ulcers in cooperation with home care nurses

Objectives: To examine the feasibility and acceptance of teledermatology for wound management for patients with leg ulcers by home care nurses and evaluate the reduction of costs and the acceptance of teledermatology by patients and home care nurses. Design: Case series of telemonitored patients with leg ulcers including cost-effectiveness analysis. Setting: Home monitoring by home care nurses. Patients: Sixteen patients with 45 leg ulcers of different origin were included. Main Outcome Measures: After an initial outpatient visit when the leg ulcers were assessed and classified, teledermatological follow-up was done by home care nurses. Relevant clinical information and I to 4 digital images of the wound and surrounding skin were transmitted weekly via a secure Web site to an expert at the wound care center, who assessed the wound and made therapeutic recommendations. Results: Of the 707 images transmitted for teleconsultation, in 644 (89%) the quality of the images was excellent or sufficient and the experts were confident in giving therapeutic recommendations. Of the 45 ulcers, 32 (71%) decreased in size and 14 (31%) healed completely, whereas 10 of the 45 ulcers (22%) increased slightly in size despite the teledermatological monitoring. In 3 ulcers (7%), no measurement was possible owing to the overly large size of the ulcers. The acceptance of telemedicine was very good by most patients. Of 15 home care nurses working in the district, 7 were very satisfied with teledermatological monitoring of wound care. There was a reduction of 46% in transportation costs for the insurance companies as well as for the patients owing to a significant decrease in the number of visits to general physicians or the wound care center. Conclusions: The acceptance of teledermatological monitoring of wound care was very high by patients, home care nurses, and wound experts. Decreased health care costs by reducing the number of visits to wound care centers or specialist physicians and improvement in quality of life for patients with leg ulcers using telernedicine seems possible. Teledermatology offers great potential for long-term wound care.