JOURNAL OF THE INTERNATIONAL SOCIETY FOR TELEMEDICINE AND EHEALTH Carpio VCet al., J Int Soc Telemed eHealth 2016;4:e28 1 STORE-AND-FORWARD TELEDERMATOLOGY USING MOBILE PHONES: CLINICAL EFFICACY IN A RURAL PRIMARY HEALTHCARE CENTRE FREE CLINIC SETTING Vanessa M Carpio MD 1 , Belen L Dofitas, MD 1 , Clarita L Maaño, MD 1 , Carmela Augusta F Dayrit MD 1 , Joahnna B Villena, MD 1 , Monica Felise A Jara MD 1 , Alvin B Marcelo MD 2 , Anthony H Cordero MD 3 1 Section of Dermatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines 2 National Telehealth Centre, University of the Philippines, Manila 3 Department of Family and Community Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines Abstract Background: Technological advances increase the feasibility of mobile-phone teledermatology (mdermatology). By saving time and costs, underserved areas lacking dermatologists may benefit greatly. Objectives: To assess the clinical efficacy of mobile-phone store-and-forward mdermatology compared to face-to-face consultation. Methods: Patients from a rural health centre in Batangas were randomised to either mdermatology or face-to-face group. In the mdermatology group, a general practitioner (GP) assessed patients, took photographs using a cell phone camera and sent these via e-mail accessed via the GP’s mobile phone to the mdermatologist’s mobile phone. In the face-to-face group, the GP assessed patients and then referred them to the face- to-face dermatologist. Both the mdermatologist and face-to-face dermatologist provided assessments and plans for patients in their respective groups. Clinical outcomes were assessed after two and four weeks. Results: A total of 123 patients were included, with 60 participants in the mdermatology group and 63 in the face-to-face group. In both groups, most participants improved. There were no significant differences in clinical outcomes assessed by GPs (p=0.074), dermatologists (p=0.172), or participants (p=0.405). The diagnostic strength of agreement between the GP and the dermatologist differed between the two groups (Cohen’s κ=0.5775 vs. 0.2735), but management concordance was similar (p=0.775). Conclusion: Store-and-forward teledermatology using mobile phones in the dermatologic management of patients in a rural primary healthcare centre free clinic setting is feasible. This study did not find mobile teledermatology inferior to face-to-face consul- tation. Keywords: telemedicine; mhealth; mdermatology; rural health; treatment outcome; efficacy; concordance. Introduction Telemedicine can improve access to specialty care and its use has been facilitated by rapid technological advances. Dermatology, due to its visual nature and ability to be captured in images, has made teledermatology an ideal use of telemedicine. Teledermatology is defined as the delivery of dermatologic care via information and communication technology. 1 It expands the reach of a dermatologist to those lacking access to specialist care. This is especially important in many Asian countries where the ratio of dermatologists to overall population is very low. 2 Store-and-forward (SF) teledermatology uses asynchronous data transmission of digital photographs and patient information for review at a later time in lieu of live-interactive/videoconferencing teledermatology. There is consistent literature evidence that SF teledermatology is economic, reliable and accurate in diagnosing skin disease, when compared with face-to- face (FTF) consultations. 3 It improves access to care, with high levels of patient and provider satisfaction, and can also lead to shorter waiting times and fewer specialist referrals. 4 However, traditional SF tele- dermatology can be tedious, time-consuming and involves use of costly equipment not available in most rural communities. With the large coverage and rapid advances of mobile phone technology, mobile phones may provide a feasible, cheaper way of delivering dermatologic care to underserved areas of the