206 APPENDICES and GPs are asked to answer these questions before and after each teledermoscopy consultation. These questions focus on GPs’ choices regarding patient referral if teledermoscopy had not been available, whether they finally referred the patient to a dermatologist after the teledermoscopy consultation, if they and the patient were helped with the teledermoscopy consultation and if they learned from the consultation. During the assessment of the teledermoscopy consultation, the teledermatologists are asked via an evaluation question in the platform whether a physical referral of the patient is necessary. In Chapter 3 we investigated the added value of teledermoscopy based on different quality and performance outcomes, using the data of 18,738 teledermoscopy consultations (February 2009 – February 2020). Several quality and performance outcome measures in this study were operationalized based on the GP and teledermatologist self-reported evaluation questions. These outcome measures included: the percentage of requests for second opinion from GPs to teledermatologists, the percentage of GPs following up on the referral advice of teledermatologists, the percentage of additional physical referrals of patients after teledermoscopy, percentages that expressed whether GPs valued the teledermoscopy consultation as helpful and instructive, the percentage of patients for whom the GPs indicated that they would have referred these patients to the dermatologist if teledermoscopy was not available, the time GPs needed to send in a teledermoscopy consultation, and the time teledermatologists needed to respond to a teledermoscopy consultation. The results of this study showed that in about 32% of the teledermoscopy consultations, the GP consulted a teledermatologist for a second opinion request for patients for whom the GP initially did not have the intention to refer them to a dermatologist. Of the respective teledermoscopy consultations, approximately 18% of the patients were subsequently referred to a dermatologist for a physical examination. Of the remaining 68% of the teledermoscopy consultations, GPs indicated prior to the teledermoscopy consultation that they would have initially referred these patients without teledermoscopy and after obtaining the teledermatologist’s advice these patients were finally not referred to the dermatologist. GPs followed up on the referral advice of teledermatologists in approximately 89% of the teledermoscopy consultations. In addition, GPs indicated that the teledermoscopy consultations were helpful (97%) and instructive (95%). The median time a GP needed to send in a teledermoscopy consultation was 5.4 minutes. The median time a teledermatologist needed to complete the teledermoscopy assessment was 2 minutes. The median response time of the teledermatologist to a GP was 2.4 hours. Furthermore, this study calculated that teledermoscopy consultation halves the cost compared to an in-person consultation and saves €144.18 (in 2020: $164.65) in patient costs for each teledermoscopy consultation performed. Teledermoscopy is thus a useful tool for GPs to consult dermatological expertise at short notice, at lower costs compared to a physical consultation, and supports them in establishing a diagnosis and in their referral decision for patients with skin lesions. In addition, GPs reported teledermoscopy as helpful and instructive, which could contribute to enhancement of their dermatological expertise.
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