190 CHAPTER 8 one large Dutch telemedicine provider and its affiliated GPs. First of all, this means that we might have underestimated the overall number of nationally performed teledermoscopy consultations. Since Ksyos is the largest store-and-forward telemedicine provider in the Netherlands, we believe that we included most Dutch teledermoscopy consultations and GPs performing store-and-forward digital dermatology care. This single telemedicine provider context further implies that some findings may only be applicable to the Dutch healthcare setting. Although, we believe that the results and lessons learned in this thesis are generalizable to other Western-European countries where GPs fulfil a similar gatekeeper role to secondary care and to digital dermatology services that are not yet implemented nationwide. Finally, we included only GPs affiliated with the telemedicine organization in the studies and excluded GPs who worked with other digital dermatology platforms and organizations or GPs who did not work with digital dermatology at all. Future research should examine the advantages of GPs working with other digital dermatology platforms and to learn why GPs are not working with digital dermatology at all. FUTURE PERSPECTIVES Patients This thesis focused on the use of digital dermatology care from the GPs’ perspective. However, future studies should also focus on experiences from other stakeholders involved in digital dermatology, such as patients and dermatologists. Overall, various teledermatology studies showed high patient satisfaction rates [31]. However, in these studies the digital contact took often directly place between the dermatologist and the patient without any involvement of the GP as actor. In contrast, in our studies, the patients had face-to-face contact for teledermatology and teledermoscopy and digital contact for dermatology home consultation with their GP. Furthermore, these literature studies used different definitions of patient satisfaction, included a narrow set of patient satisfaction aspects, or included self-deployed questionnaires which were not validated [31]. In other words, standardized and validated questionnaires to evaluate these services based on all quality aspects of teledermatology from the patient’s perspective are lacking. Therefore, in a prior study that we performed in Dutch GP practices, using the same Dutch teleconsultation platform, we attempted to develop such a questionnaire [32,33]. The active role of the patient is yet limited in Dutch teledermatology and teledermoscopy consultations. This was confirmed by preliminary results of this questionnaire study: patients indicated having a passive role and hardly experienced receiving a digital dermatology consultation (the GP takes detailed and overview photographs of the patient’s skin lesion as part of a regular GP consultation, completes the consultation request with additional patient information, and receives a diagnosis of the TD). Therefore, during the first attempts to validate this questionnaire, we experienced that it was difficult for patients to respond to all the quality aspects of the questionnaire and many questions were left unanswered.
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