Implementation of Remote Monitoring of Topical Treatments in Patients with a History of Cutaneous Malignancy

Lack of access to specialty dermatologic care puts patients with skin conditions at risk for poor health outcomes. Skin cancer mortality is also lower in areas with high specialty dermatologist density. Because the Huntsman Cancer Institute is the only National Cancer Institute-Designated Comprehensive Cancer Center in the vast Mountain West region, skin cancer patients who live many miles away are at risk for poor health outcomes. Local Problem At the Huntsman Cancer Institute, some patients with a history of cutaneous malignancies are prescribed topical therapies that can come with side effects that traditionally have only been managed in person. Frequent in-person follow-ups are challenging for many patients and reduce the efficiency of providers as well as clinic time and resources. Methods This quality improvement project used qualitative surveys in an open-ended discussion format to assess existing protocols regarding topical therapy management and healthcare team member attitudes regarding remote monitoring for patients in this setting. Based on the assessment of existing topical therapy treatment, a practice guideline was developed and adapted for remote monitoring to be mediated by the healthcare team. These open-ended surveys were used to assess the feasibility, usability, satisfaction, and sustainability perceived by the healthcare team members before and after the implementation period. Interventions The practice guideline was initially constructed with input from local providers. Then, the healthcare team nurses and medical assistants were trained on the use of the practice guidelines. The providers identified eligible patients in the clinic and enrolled them in remote monitoring of topical therapy that replaced traditional in-person follow-up. The healthcare team then carried out this implementation over a nine-week period. Results A total of 16 patients were enrolled in remote monitoring for follow-up of topical therapy, of which 13 (81.3%) successfully completed their regimen during the implementation window. Nine (56.3%) of these patients required interventions captured remotely by the care team. Five (71.4%) of the healthcare team participants reported having no persistent reservations about remote monitoring, and all healthcare participants (n=7) reported that they believe there is long-term potential with remote monitoring in this setting. Conclusion This quality improvement project revealed that remote monitoring could be a promising adjunctive option for care delivery in the cutaneous oncology setting. This could improve patient care access while simultaneously reducing travel time and costs for patients, as well as improving health outcomes. This could also improve system-side resource utilization, including exam rooms, time, and increasing availability for staff and providers to see higher acuity patients. Additional research and refinement of this type of intervention must be included in future efforts to determine additional barriers, facilitators, benefits, and costs associated with this type of care delivery in this setting.