153 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC consultations [6]. Although the telemedicine contexts may differ in other countries, our results also provide general facilitators and barriers that apply to the adoption and implementation of digital dermatology consultation in preliminary stages or other contexts. Future research could involve a more extensive study that would allow us to examine what contextual and other factors (e.g., age, the number of years of practice, and the type of practice) influence GPs’ perceptions and use of remote dermatology services. The third limitation is that our study was questionnaire based, with the typical limitations of incomplete responses and low response rates. The questionnaire was administered at the end of 2021, when a COVID-19 mandated national lockdown, social distancing, and stay-at-home mandates were announced. We assume that the low participation rate might be owing to GPs’ limited time and increased workload. We tried to increase the response rate by sending 1 reminder via email but did not want to burden GPs in such a hectic time. CONCLUSIONS Remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs to the use of the service. However, barriers impeded the full potential of its successful use by GPs during the pandemic and may limit the continuity of the service in GP practices in the future. The training of GPs is needed to effectively use the imaging equipment and to guarantee adequate quality of taken (dermoscopy) images. Furthermore, GPs should be trained when (not) to use the digital dermatology service. In addition, the remote dermatology platform should be improved to guide patients in taking photographs with sufficient quality. The identification of these barriers provides insights to telemedicine organizations, health institutions, and policy makers to guide digital dermatology implementation and sustainability. ACKNOWLEDGMENTS The authors would like to thank the general practitioner (GP) and GP resident for reviewing the COVID-19 and GP-specific questions in the questionnaire, all GPs who completed the questionnaire and shared their perspectives, and Ksyos for sending the questionnaire. The authors also thank Femke van Sinderen for contributing to the preparation and distribution of the questionnaire, Miranda Roskam-Mul for the LimeSurvey support, Bibiche Groenhuijzen for contributing to the data analysis, Danielle Newton for reviewing the English translations of the GP quotes and the questionnaire in Appendix 7.1, and Leonard Witkamp and Job van der Heijden for reviewing the manuscript. 7
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