186 CHAPTER 8 the potential of teledermatology and teledermoscopy services usage is limited by the quality of the photographs taken by GPs. Therefore, training of GPs in taking (dermoscopic) images and how to use the photography devices should be considered [21]. Some GPs follow extra dermatology courses or refresher courses to maintain and improve their dermatological knowledge in order to stay abreast of current developments [7]. However, we know from practical experience that several GPs only use digital dermatology a few times a year. Such a long time span between uses might diminish their learned skills and knowledge [22]. Therefore, we recommend accredited continuous online and good practice training sessions and video instructions to refresh GPs’ knowledge about the use of (dermoscopy) imaging equipment and how to obtain adequate photographs. Trainings accredited by the European Accreditation Council for Continuing Medical Education [23] could encourage GPs to take part in training sessions and could enhance the use of digital dermatology services. Last, GPs have different views on when and for which skin lesions they can or cannot use digital dermatology services. Thus, apart from basic dermatology knowledge for GPs, educational programs and refresher courses should focus on for which skin conditions the digital dermatology service can be useful. Facilitate up-to-date, appropriate, and affordable imaging equipment This thesis also confirmed that the quality of overview, detailed and dermoscopic images is not only influenced by the photography skills of the GP, but also by the type and modernity of the photography devices used in daily practice. Appropriate imaging equipment is a prerequisite to take high-quality dermatology photographs and successfully use digital dermatology services. The quality of the imaging devices has evolved over the past years to an extent that the currently available equipment should be sufficient to take high-quality skin images, but the photographs taken by GPs are still not always of sufficient quality. This is partly because GPs lack up-to-date and appropriate digital dermatology imaging equipment, such as mobile dermoscope attachments compatible with GPs’ smartphones. The unavailability of these up-to-date and appropriate imaging equipment, along with equipment costs, limits the use of digital dermatology by GPs [7,24,25] and affects the clinical justification of the TD’s advice based on the photographs. Developments in imaging equipment and technology are improving rapidly but GPs need to buy these latest (dermoscopy) off-the-shelf equipment themselves. Despite that off-the-shelf dermoscopy mobile phone attachments are on the market for a few hundred euros or US dollars and most GPs own a self-purchased eligible smartphone, GPs indicate that free-of-charge offered up-to-date image taking equipment would incentivize their use. GPs are not only accountable for purchasing the latest dermatology equipment, but also for purchasing equipment and devices for innovations in all other medical specialties. A solution for avoiding these costs for GP practices could be that telemedicine organizations or health insurance companies purchase these up-to-date and appropriate imaging equipment and facilitate the equipment free-of-charge to GP practices in return for using the tooling.
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