Comparative Analysis of Dermatology Telemedicine vs. In-Person Outcomes for Acne

Thesis Abstract

Telemedicine has emerged as a transformative modality in dermatology, offering remote access to expert care for acne management; however, evidence on its comparative effectiveness relative to traditional in-person consultations remains heterogeneous, with implications for clinical outcomes, patient satisfaction, and health system efficiency. This study aims to evaluate differences in acne-related clinical outcomes, adherence, patient satisfaction, and resource use between dermatology telemedicine and in-person consultations, and to identify factors moderating these outcomes. Specifically, the objectives are (1) to compare lesion count reduction and global assessment scores after a 12-week treatment course between telemedicine and in-person modalities; (2) to assess patient adherence to prescribed regimens and follow-up schedules across groups; (3) to examine patient satisfaction, accessibility, and perceived quality of care; (4) to evaluate time-to-treatment initiation, visit duration, and cost per encounter; and (5) to explore how patient demographics, acne severity, and comorbidities moderate treatment response. The study adopts a prospective, multi-center, cross-sectional design complemented by a longitudinal component for a 12-week follow-up. The population comprises patients aged 16–45 with a clinical diagnosis of facial acne vulgaris seeking dermatology care at three urban tertiary centers. A stratified random sampling approach will enroll 300 participants, with 150 allocated to telemedicine pathways and 150 to in-person visits, ensuring comparable baseline severity (Investigator's Global Assessment grades 2–3). Data collection instruments include standardized acne severity scales (Global Acne Grading System, Investigator’s Global Assessment), validated adherence measures (Medication Event Monitoring System logs and self-reported adherence), patient satisfaction instruments (Dermatology Satisfaction Questionnaire), and health service utilization instruments capturing visit duration, travel time, and direct costs. Instrument validity and reliability will be established through pilot testing and Cronbach’s alpha estimates (>0.70) for multi-item scales. Data analysis will proceed with descriptive statistics to summarize baseline characteristics, followed by inferential analyses. Primary outcomes will be analyzed using analysis of covariance (ANCOVA) to compare post-treatment acne severity between groups, adjusting for baseline severity and covariates. Multiple regression models will assess the association between treatment modality and adherence, satisfaction, and cost per patient, controlling for demographic and clinical factors. A mixed-effects model will address repeated measures across the 12-week follow-up. Mediation analyses will explore whether adherence and time-to-treatment mediate the relationship between modality and clinical outcomes. Theoretical framing will draw on the Technology Acceptance Model (TAM) to interpret patient acceptance of telemedicine and the Health Belief Model to understand adherence behaviors, with supplementary reference to the Diffusion of Innovations framework for adoption patterns across centers. The study anticipates that telemedicine will demonstrate non-inferiority to in-person care in terms of acne severity reduction, with potential advantages in accessibility and reduced indirect costs, but potential disparities in satisfaction for patients with severe disease or limited digital literacy. Expected findings include comparable lesion count reductions (mean difference within a non-inferiority margin of 0.5 on the Global Acne Grading System) and similar or higher adherence rates in the telemedicine group, contingent on robust digital engagement. The study contributes to knowledge by providing rigorous, prospectively collected, multi-site evidence on the comparative effectiveness, efficiency, and patient-perceived quality of teledermatology for acne management, informing clinical guidelines and policy decisions regarding scalable telemedicine adoption. The main conclusion is anticipated to support the effectiveness and cost-efficiency of telemedicine as a viable alternative to traditional visits for acne, with caveats regarding patient selection, digital literacy, and ongoing monitoring. Recommendations include implementing standardized telemedicine protocols, ensuring equitable access through digital literacy support and device access programs, and integrating telemedicine with structured follow-up schedules and remote monitoring to optimize outcomes across diverse patient populations.