10 CHAPTER 1 GPs face in the use of the service, and the reasons for the stagnation in the use of digital dermatology on a national level are studied. Figure 1.1: Number of digital dermatology consultations registered by a telemedicine organization in the Netherlands delivering teledermatology services. The first section of this general introduction discusses the setup of standard dermatology care in Dutch GP practices. The second section provides an overview of the involved actors and delivery modalities of teledermatology. The third section zooms in on the teledermatology flow of a telemedicine organization in the Netherlands delivering teledermatology services. The fourth section addresses the use of the service during the COVID-19 pandemic and the implementation complexity of teledermatology. The last section of this chapter specifies the aims of the studies and the outline of this thesis. STANDARD DERMATOLOGY CARE IN DUTCH GP PRACTICES In the Netherlands, GPs act as gatekeepers for secondary care, which includes specialist dermatology care. GPs are the first-line contact for patients seeking specialist dermatology care and in this way play an essential role in triaging patients with skin lesions. Patients thus only have access to a dermatologist through a referral by a GP. GPs assess patients’ skin lesions and decide whether further diagnostics (such as a digital dermatology consultation, skin culture or biopsy) are needed. If further diagnostics are indicated, they might directly refer the patient to a dermatologist or start a digital dermatology consultation. If no further diagnostics are needed, they manage the skin
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