19 GENERAL INTRODUCTION to guarantee the quality, continuity and higher uptake of the digital dermatology services in the Netherlands. AIMS OF THIS THESIS The general objective of this thesis is to evaluate the value of store-and-forward teledermatology, teledermoscopy, and dermatology home consultation for Dutch GP practice. Furthermore, this thesis aims to explore the facilitators and barriers in the uptake of these digital dermatology services by GPs and to provide recommendations for future practice and research. First, we aimed to gain insight into the worldwide status of two decades (1995 – 2015) of teledermatology by performing a literature review (Part I). Second, we aimed to understand the impact and added value of performing store-and-forward teledermoscopy for GPs in Dutch GP practice (Part II). Lastly, our objective was to determine GPs’ perspectives about store-and-forward teledermatology, teledermoscopy, and dermatology home consultation in Dutch GP practice and to examine those factors that facilitate or impede the successful implementation and use of the services. To realize this aim, we developed, validated, and applied a quality feedback tool for store-and-forward telemedicine services (Part III). OUTLINE OF THIS THESIS Part I: Status of digital dermatology worldwide Chapter 2 reviews two decades of worldwide teledermatology research in the literature concerning: the actors involved in the teledermatology process, purposes and subspecialties of teledermatology services, delivery modalities and technologies used, business models used, the integration of teledermatology into national health infrastructures, preconditions and requirements for implementation, and the surplus merits. Part I will give an overview of the status worldwide before we zoom in on teledermoscopy use in Dutch GP practice in part II. Part II: Value of store-and-forward teledermoscopy in Dutch GP practice Part II includes three retrospective studies and focuses on the added value of the storeand-forward teledermoscopy consultations for GPs in Dutch primary care. For these studies, we use for example data on the GP and TD self-reported evaluation questions and TD diagnoses embedded in the digital dermatology platform. In Chapter 3 we evaluate teledermoscopy quality and performance outcomes in Dutch primary care based on 11 years of teledermoscopy data (February 2009 – February 2020). Quality outcomes are operationalized as the percentage of GPs’ second opinion requests to TDs, percentage of extra teledermoscopy referrals, percentage of GPs following up on TDs’ referral advice, and percentages of GPs who valued the teledermoscopy consultation as helpful and instructive. Performance outcomes are defined as the percentage of patients that would 1
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