{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:20:16Z","timestamp":1791958816270,"version":"4.3.4"},"reference-count":22,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","license":[{"start":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T00:00:00Z","timestamp":1707264000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Skin diseases are a major public health concern in Indonesia, although access to specialized care in remote areas is limited. We initiated a low-cost teledermatology service in Sumba, a remote island in eastern Indonesia. Eighteen healthcare workers (HCWs) at five primary healthcare centers received training to manage common skin diseases and submit clinical cases beyond their expertise to an online platform. Submitted cases were reviewed by at least one dermatologist. Diagnostic agreement between HCWs and dermatologists was calculated. The HCWs participated in a satisfaction survey 2\u2009years after project initiation. Since October 2020, of 10,384 patients presenting with skin complaints in a 24-month period, 307 (3%) were submitted for a teledermatology consultation. The most frequent skin diseases were infections and infestations (<jats:italic>n<\/jats:italic> = 162, 52.8%) and eczematous (85, 27.7%) and inflammatory (17, 5.5%) conditions. Fifty-three patients (17.3%) were diagnosed with a neglected tropical skin disease, including leprosy and scabies. Dermatologist advice was provided within a median of 50\u2009minutes (interquartile range, 18\u2013255\u2009minutes), with 91.9% of consultations occurring within 24\u2009hours. The diagnostic agreement level between HCWs and dermatologists significantly improved over time, from 46.9% in the first 6-month period (\u03ba = 0.45; 95% CI, 0.37\u20130.54) to 77.2% in the last 6-month period (\u03ba = 0.76; 95% CI, 0.67\u20130.86; global <jats:italic>P<\/jats:italic> &lt; 0.001). The HCWs reported that the teledermatology service was extremely\/very useful in supporting daily practice (100%) and improved their knowledge of skin diseases tremendously\/a lot (92%). Teledermatology can improve accessibility and quality of skin services in medically underserved areas, providing opportunities for scalability and knowledge transfer to frontline HCWs.<\/jats:p>","DOI":"10.4269\/ajtmh.23-0218","type":"journal-article","created":{"date-parts":[[2024,1,2]],"date-time":"2024-01-02T19:43:36Z","timestamp":1704224616000},"page":"364-369","source":"Crossref","is-referenced-by-count":13,"title":["Teledermatology to Improve Access to and Quality of Skin Care in Eastern Indonesia"],"prefix":"10.4269","volume":"110","author":[{"given":"Fidelis J.","family":"Adella","sequence":"first","affiliation":[{"name":"Sumba Foundation, Sumba, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hapu","family":"Ammah","sequence":"additional","affiliation":[{"name":"Sumba Foundation, Sumba, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gladys O.","family":"Siregar","sequence":"additional","affiliation":[{"name":"Sumba Foundation, Sumba, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Harianja","sequence":"additional","affiliation":[{"name":"Sumba Foundation, Sumba, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evivana S.","family":"Sundari","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Siloam Hospital, Kupang, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahmat","family":"Sagara","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Tarino","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raph L.","family":"Hamers","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"B\u00f8gh","sequence":"additional","affiliation":[{"name":"Sumba Foundation, Sumba, Indonesia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardyanto","family":"Soebono","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Gadjah Mada University, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlous L.","family":"Grijsen","sequence":"additional","affiliation":[{"name":"Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Invest Dermatol","first-page":"1527","article-title":"The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions","volume":"134","author":"Hay","year":"2014"},{"key":"b2","year":"2023"},{"key":"b3","series-title":"Lancet Reg Health West Pac","first-page":"100400","article-title":"Equity of health financing in Indonesia: a 5-year financing incidence analysis (2015\u20132019)","volume":"21","author":"Cheng","year":"2022"},{"key":"b4","series-title":"Lancet","first-page":"75","article-title":"Universal health coverage in Indonesia: concept, progress, and challenges","volume":"393","author":"Agustina","year":"2019"},{"key":"b5","series-title":"State of Health Inequality: Indonesia","year":"2017"},{"key":"b6","series-title":"Trans R Soc Trop Med Hyg","first-page":"384","article-title":"A population-based prevalence survey of skin diseases in adolescents and adults in rural Sumatra, Indonesia, 1999","volume":"95","author":"Saw","year":"2001"},{"key":"b7","series-title":"Hum Resour Health","first-page":"38","article-title":"A scoping analysis of the aspects of primary healthcare physician job satisfaction: facets relevant to the Indonesian system","volume":"17","author":"Maharani","year":"2019"},{"key":"b8","series-title":"Front Med (Lausanne)","first-page":"594695","article-title":"Factors associated with working in remote Indonesia: a national cross-sectional study of early-career doctors","volume":"8","author":"Putri","year":"2021"},{"key":"b9","series-title":"Hum Resour Health","first-page":"93","article-title":"Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review","volume":"18","author":"Putri","year":"2020"},{"key":"b10","series-title":"Soc Sci Med","first-page":"30","article-title":"Addressing the unequal geographic distribution of specialist doctors in Indonesia: the role of the private sector and effectiveness of current regulations","volume":"82","author":"Meliala","year":"2013"},{"key":"b11","series-title":"Profil Kesehatan Indonesia Tahun 2021","year":"2022"},{"key":"b12","series-title":"Trop Med Infect Dis","first-page":"E88","article-title":"A teledermatology pilot programme for the management of skin diseases in primary health care centres: experiences from a resource-limited country (Mali, West Africa)","volume":"3","author":"Faye","year":"2018"},{"key":"b13","series-title":"Front Public Health","first-page":"387","article-title":"Teledermatology use in remote areas of French Guiana: experience from a long-running system","volume":"7","author":"Messagier","year":"2019"},{"key":"b14","series-title":"Br J Dermatol","first-page":"265","article-title":"Mobile teledermatology for a prompter and more efficient dermatological care in rural Mongolia","volume":"173","author":"Byamba","year":"2015"},{"key":"b15","series-title":"Adv Soc Sci Educ Humanit Res","first-page":"328","article-title":"Mobile instant messaging for mobile learning activity: use of WhatsApp group as a mobile learning platform in Anak Pintar Community","volume":"494","author":"Fatimah","year":"2020"},{"key":"b16","series-title":"JAAD Int","first-page":"95","article-title":"Burden of skin disease and associated socioeconomic status in Europe: an ecologic study from the Global Burden of Disease Study 2017","volume":"1","author":"Chu","year":"2020"},{"key":"b17","series-title":"Telemed J E Health","first-page":"1022","article-title":"Use of teledermatology to improve dermatological access in rural areas","volume":"25","author":"Coustasse","year":"2019"},{"key":"b18","series-title":"J Telemed Telecare","first-page":"494","article-title":"Teledermatology for primary care in remote areas in Brazil","volume":"19","author":"Assis","year":"2013"},{"key":"b19","series-title":"Int J Dermatol","first-page":"228","article-title":"WhatsApp platforms in tropical public health resource-poor settings","volume":"58","author":"Hogan","year":"2019"},{"key":"b20","series-title":"Telemed J E Health","first-page":"464","article-title":"WhatsApp: an innovative tool for dermatology care in limited resource settings","volume":"24","author":"Williams","year":"2018"},{"key":"b21","series-title":"PLoS One","first-page":"e28687","article-title":"Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists","volume":"6","author":"Armstrong","year":"2011"},{"key":"b22","series-title":"Dermatol Online J","first-page":"13030\/qt75p7q57j","article-title":"Digital future of dermatology","volume":"26","author":"Glines","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/2\/article-p364.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/2\/article-p364.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/110\/2\/article-p364.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T12:51:31Z","timestamp":1744980691000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/110\/2\/article-p364.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,7]]},"references-count":22,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.23-0218","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,7]]}}}