204 APPENDICES SUMMARY General practitioners (GPs) manage patients with low-complex or common skin conditions (such as acne, eczema, skin rash, benign moles, etc.) themselves in their practice with a wait-and-see policy or medical treatment. Furthermore, they can determine if further diagnostics are needed, such as a skin culture for skin infection, a biopsy, a digital dermatology consultation, or a physical referral to a dermatologist, for example, in case of suspicion of skin cancer. Fourteen percent of the patient complaints in GP practice are skin-related and most of these skin complaints are treated by GPs themselves in their own practice. In addition, GPs act as gatekeepers to secondary care and the majority of their referrals are for specialized dermatology care. In recent years, there has been an increasing shortage and outflow of GPs while several tasks have been shifted to primary care. Furthermore, the pressure on Dutch healthcare has increased due to the growing aging population, which has increased both the incidence and patients’ awareness regarding skin cancer, as well as the number of patients requesting assessments of nevi or other skin lesions. Moreover, GPs experience challenges in diagnosing skin disorders, especially in discriminating (pre)malignant and benign skin lesions and diagnosing skin cancer. To support GPs in diagnosing these (suspicious) skin lesions in general practice, they can seek the advice of a teledermatologist through digital dermatology services. In addition, they can also use digital dermatology services to prevent physical referrals to dermatology practice for patients with low-complex dermatological questions. In this way, primarily patients with complex or severe skin lesions or patients who require specialized care outside the scope of the GP are referred to the dermatologist. The Netherlands was the first country where digital dermatology services had already been nationally integrated into GP practices and reimbursed by health insurance companies (since 2006). Despite proven successes and expectations about the potential of digital dermatology services to address current healthare challenges, the growth of these promising services in the Netherlands stabilized before the COVID-19 pandemic. Therefore, the possible reasons for stagnation in the use of digital dermatology services, the added value of the services for GPs and the challenges that GPs face while using the services are explored in this thesis. Ksyos is a digital hospital (also referred to as a telemedicine organization) in the Netherlands that provides such store-and-forward digital dermatology services nationwide. This thesis focuses on three types of store-and-forward digital dermatology services, facilitated by this Dutch telemedicine organization: (1) teledermatology, (2) teledermoscopy and (3) digital dermatology home consultation. With teledermatology, GPs visually capture a patient’s skin lesion with a digital camera, smartphone or tablet and send the detailed and overview photographs together with the medical history of the patient, anamnesis and a focused question to a teledermatologist for advice. When one or more digitalized dermoscopic photographs are taken of the patient’s skin lesion in addition
RkJQdWJsaXNoZXIy MTk4NDMw