24-Hour Anonymous Medical Information Service Using the Mobile Telephone in Sweden: A Pilot g p Study during the Summer of 2008 Alexander Börve MD Sahlgrenska University Hospital, Gothenburg, Sweden g, alexander@iDoc24.se
Disclosure of interest• Alexander Börve is the owner of iDoc24 AB• No incentives were given to the dermatologists in the doctor survey
Study questions• Can a mobile telephone advice service be used between the citizen and a dermatologist?• Can dermatologists be consequent on diagnosis from a MMS?• W the system valid? Was h lid?• Can the service be medically sound?
The service• Anonymous medical information within 24 hours on any visual concern from a specialist d t – using MMS i li t doctor i• Medical information consisted of a probable diagnosis in Swedish, the medical term treatment information and term, advice to see a doctor in person if needed
Study segment• Sailors and Swedish tourists on the west coast of Sweden (Bohuslän) ( )• 1st July- 31st August 2008
Study St d recruits it10 000 flyers werehanded out and put onboats
Result18 consultations were answered within 24h
Doctor survey• A po er point presentation with 10 cases power ith from the summer test was presented to 10 dermatologists• 1 specialist with 25 years experience• 1 specialist with 6 years experience• 8 with 4 years experience
Case SE0807AFC3• A musquito bit me and it itches, do you have any advice for relief?
Case SE0807F547• I am a 13 year old girl, played fotball and got a rash on the inside of my knee, it does´t hurt, no fever, i take no medicine
Case SE08082F92• Rash on the small toe. And also alittle bit on the toe next to it. I saw it this morning, no symptoms. Small rashes between the toes
Case SE0807366A• I have had a varying rash and redness under one year year.
Dermatology assessment 10 power point cases resultsCase Diagnosis Alternative diagnosis Treatment Alternative treatment Body part Picture quality 10 concurred with arthropod 1 Antihistamine Local steroid cream Wrist Good picture quality reaction 6 concurred with Herpes Refobacin cream, see 2 Haemangioma H i Information I f i Left L f pectoral l Bad i B d picture quality li simplex you doctor 3 10 concurred with striae Information Physical exercise Buttocks Bad picture quality 10 concurred with erythema 4 Antibiotics See your doctor Inside knee Good picture quality migrans 7 concurred with perinasal Refobacin cream, right nose 5 2 said impetigo Mild cortisone Bad picture quality eczema moisturiser opening 6 4 concurred with petequia Lichen planus, vacuities, See your doctor Back of hand Bad picture quality 7 3 concurred with eczema Tinea Cortisone cream See your doctor 2nd toe Bad picture quality 10 concurred with arthropod Rest arm, information, Between 2nd & 8 Eczema, urticaria Antihistamine Bad picture quality reaction wait and see 3rd finger 6 concurred with viral Whole stomach 9 Urticaria, measles Antihistamine See your doctor Medium picture quality exanthema and chest10 7 concurred with rosacea Acne, contact dermatitis Rozex, tetralysal, See your doctor Right face Bad picture quality
Results• 10/10 could diagnose Lyme disease• 10/10 could diagnose striae• 10/10 could diagnose arthropod reaction• Where there was varying agreement was with acne, rosacea, viral exanthema, tinea and eczema
What the users thought• Many though it was complicated to follow through with a consultation. – Activating MMS with the operator – Completing a MMS with p p g prefix and text
Web survey result• 7 users a s e ed ou su ey use s answered our survey – 5/7 were satisfied with the service – 5/7 trusted the answer – 5/7 used the answer for self treatment – 3/7 searched for more information on the internet – 2/7 to show to friends – 2/7 went to the doctor
Study answers• Can a mobile telephone advice service be used between the iti th citizen and a d d dermatologist? t l i t? – Yes as an advice service, but not a final consultation service• Can dermatologists be consequent on diagnosis from a MMS? – T some extent To t t• Was the system valid? – Yes• Can the service be medically sound? – As an anonymous advice service yes, but cannot y y substitute an ordinary doctor patient consultation
Conclusion• Complement to using the internet for self diagnosis and self treatment on clear diagnoses• Complement to national governmental telephone and internet medical information services• Potentially avert citizens with common dermatosis that are treatable with prescription p p free medication• Book an appointment with their general practitioner titi• More research should be done to find economically viable models and medically sound services that encourage patient well-being