180 CHAPTER 8 This thesis aimed to contribute to the understanding of the value of store-and-forward teledermatology, teledermoscopy and dermatology home consultation in Dutch general practitioner (GP) practice. Furthermore, it aimed to add insights into experienced facilitators and barriers in the uptake of these digital dermatology services by GPs since its introduction in primary GP care. First, we investigated the status of two decades (1995 – 2015) of teledermatology worldwide by performing a literature review (Part I). Second, we researched the impact and added value of performing store-and-forward teledermoscopy for GPs in Dutch GP practice (Part II). Lastly, we developed and validated a quality feedback tool (SAF-TSUQ) to determine GPs’ perspectives about store-andforward telemedicine services. We applied and extended this SAF-TSUQ (with open and closed-ended questions on the use of digital dermatology care during the COVID-19 pandemic) to reveal the factors that facilitate or impede the successful implementation and use of teledermatology, teledermoscopy and dermatology home consultation services in Dutch GP practice (Part III). This final chapter provides a summary of the main findings, a general discussion and conclusion on how teledermatology, teledermoscopy and dermatology home consultation are valued and received in Dutch GP practice. We discuss the added value and challenges contributing to the successful implementation and use of these services in Dutch GP practice and provide recommendations for future practice. These recommendations are primarily relevant since the rapid evolvement of digital health applications during the COVID-19 pandemic and because of the high pressure of healthcare agreements to implement digital care in the Netherlands. Furthermore, this chapter points out the strengths and limitations of the studies in this thesis and provides suggestions for future research. MAIN FINDINGS Part I: Status of digital dermatology worldwide In Chapter 2 we reviewed two decades of worldwide teledermatology research regarding the actors involved in the teledermatology process (patient, GP, dermatologist), purposes (patient triage and follow-up, dermatologist consultation, education of GPs and dermatologists, etc.) and the subspecialties of teledermatology services (such as teledermoscopy). Additionally, this literature review investigated the delivery modalities and technologies used in teledermatology (store-and-forward, real-time or hybrid), business models used, the integration of teledermatology into national health infrastructures, preconditions and requirements for implementation, and the surplus merits of teledermatology services. The results indicated that teledermatology is an efficient and effective healthcare service compared to conventional in-person dermatology care. More specifically, this study showed that teledermatology services lower costs, reduce patients’ travel and wait time, avoid (unnecessary) physical visits to the dermatologist, and improve access of care for patients geographically underserved to dermatology
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