205 APPENDICES to detailed and overview photographs, this is called teledermoscopy. Teledermoscopy is often used for diagnosing suspicious skin lesions and can assist GPs in distinguishing between benign skin lesions or potentially life-threatening skin malignancies (melanoma). Digital dermatology home consultation means that patients with skin complaints take photographs with their own smartphone and directly exchange information with their GP without a physical visit to the GP practice. The general objective of this thesis is to evaluate the value of store-and-forward teledermatology, teledermoscopy, and dermatology home consultation in 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 on sustainable implementation and upscaling of these services. Part I: Status of digital dermatology worldwide In Chapter 2 we conducted a PubMed literature study to provide an overview of two decades (1995 – 2015) of worldwide digital dermatology research. After title and abstract selection, 114 publications and 14 reviews were included for full-text reading. The literature review focused on 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). In addition, 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 finally the surplus merits of teledermatology services were examined in this review. The results showed that teledermatology services are efficient and effective compared to standard physical dermatology care because these healthcare services lower costs, reduce wait and travel time for patients and prevent physical referrals to the dermatologist. Furthermore, teledermatology services improve access for patients in countries with long waiting lists for dermatology care or for patients geographically underserved to dermatology care. This analysis additionally demonstrated that the Netherlands was, at the time of this review, the only country where teledermatology has been reimbursed in the national healthcare system (since 2006) and where the service has been broadly integrated between primary GP care and secondary dermatology care. Part II: Value of store-and-forward teledermoscopy in Dutch GP practice Part II zoomed in on store-and-forward teledermoscopy and we retrospectively studied the added value of these teledermoscopy consultations for GPs in Dutch primary care. The data analyses in part II used the optionally entered GP diagnoses and the mandatory provided teledermatologist diagnoses, teledermoscopy turnaround times, and responses to the GP and teledermatologist self-reported teledermoscopy evaluation questions. These evaluation questions are embedded by default in the digital dermatology platform A
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