Teledermatology by dermatologists helpful following patient selection by general practitioners

January 01, 0001

Teledermatology by dermatologists helpful following patient selection by general practitioners

Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed. This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP). Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology. 1,820 GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included.

In the group of patients where the GP used teleconsultation to prevent a referral (n = 26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n = 10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4.6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%.

The researchers concluded: "Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care."

Dermatologists can be very busy and fee-for-service may be an issue (the cost savings given in the article cannot be generalized). Upskilling GPs in Dermatology is also important.

For the full abstract, click here.

British Journal of Dermatology 165(5):1058-1065 , November 2011 © 2011 to John Wiley & Sons, Inc.
Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. J.P. van der Heijden, N.F. de Keizer, J.D. Bos et al.

Category: S. Skin, HSR. Health Services Research. Keywords: teledermatology, telemedicine, efficacy, quality of care, costs, prospective study, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 18 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.