149 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC study took a (follow-up) imaging course. Although most GPs were satisfied with the training they received or indicated that they felt no need for (additional) training, many photograph quality issues were revealed in our study. This shows that training of people influences the quality of the images captured during a remote dermatology consultation. Furthermore, more than one-third (25/66, 38%) of the GPs used the telemedicine platform monthly or only a few times in a year. Such a long interval between uses might dilute their acquired skills and knowledge [41]. Therefore, our results suggest that GPs need continuous web-based and good practice training sessions and video instructions as refreshers (e.g., instructions to refresh their knowledge about the use of the equipment to capture images and how to use the platform). We propose that these training sessions are accredited by the European Accreditation Council for Continuing Medical Education, which might stimulate GPs across Europe to participate in training sessions and to use digital dermatology services [42]. Furthermore, (video) instructions about how to obtain adequate photographs and an understandable, straightforward, step-by-step (webbased) guide for GPs and patients should be provided by the telemedicine organization to mitigate the image quality barrier in the future. In addition, our results showed that the quality of the (dermoscopic) images was not only dependent on the photography skills of the patients and GPs but also on the imaging devices used in daily practice. These equipment issues related, among others, to the (outdated) mobile dermoscope attachments that were not compatible with GPs’ new phones. Problems with their imaging equipment can limit GPs from using this equipment or continuing digital dermatology care [11]. Furthermore, a study conducted 10 years ago with the same Dutch teledermoscopy platform already reported equipment issues regarding failing or empty camera batteries and attaching and detaching the dermoscope [41]. Although technology and imaging equipment have developed enormously in recent years, GPs reported that the lack of appropriate up-to-date imaging equipment and equipment costs still hindered their digital dermatology use. Although most GPs own a self-purchased appropriate smartphone device and off-the-shelf dermoscopy attachments are available for a few hundred euros or US dollars, GPs in our study reported that they would appreciate it and consider it as an incentive if imaging equipment would be offered for free by the telemedicine organization. Costs to purchase the imaging equipment was also mentioned in other teledermatology and teledermoscopy studies as a barrier [4345]. These findings show that the internal organizational policies regarding equipment influence the availability of appropriate hardware and software by GPs and that the lack of use of appropriate equipment directly influences the ability to clinically justify teledermatologists’ advice based on the images. Therefore, solutions for purchasing or hiring up-to-date adequate imaging equipment for GP practices should be considered by telemedicine organizations. Besides the issues with photography skills and the equipment, the human-computer interface and interoperability issues with the telemedicine platform might have influenced 7
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