209 APPENDICES quality, and (4) questions related to the impact of the COVID-19 pandemic on the use of digital dermatology services in practice. We applied an 8-dimensional sociotechnical model to analyze the free-text responses and to investigate the sociotechnical facilitating factors and barriers that GPs experienced when using teledermatology, teledermoscopy, and dermatology home consultation. Forty GPs (1%) were unreachable by email or unsubscribed from the study. Overall, 71 GPs (2%) completed the entire questionnaire. Six questionnaires were excluded for the data analysis as these GPs did not consent to use their data for research purposes. Sixty-six questionnaires remained for data analysis. The results showed that GPs were generally satisfied with the already existing store-andforward digital dermatology service, the platform, and the telemedicine organization. Nevertheless, interrelated usage barriers were identified that limited the full potential and use of these dermatology services during the pandemic. These barriers included GPs’ digital photography skills, the costs and lack of up-to-date and appropriate photography equipment, human-computer interface and interoperability issues on the digital dermatology platform, and different use procedures of the digital dermatology service. Training could improve the use of photography equipment by GPs and thus enhancing the quality of (dermoscopic) photographs taken by them. The use of digital health applications and dermatology education have been underrepresented in the GP training curricula. Only a few GPs in our study indicated that they received training in taking (dermoscopic) photographs during their GP training. Approximately half of the GPs in our study indicated that they had received an introductory training in taking (dermoscopic) photographs by the telemedicine organization. Most GPs obtained this knowledge regarding taking (dermoscopic) images in clinical practice. Furthermore, training could inform GPs in which circumstances they can or cannot use digital dermatology. In addition, solutions must be sought for purchasing or hiring up-to-date, adequate photography equipment and for issues related to the human-computer interface and the interoperability of the platform. Health insurers could offset the costs of purchasing appropriate photography equipment with the costs saved by preventing unnecessary physical referrals to a dermatologist. As a result, the use of digital dermatology ultimately means that health insurers save healthcare costs. Moreover, 15% of the GPs mentioned that they used dermatology home consultation during the pandemic. This means that patients themselves took photographs of their skin complaints with their own smartphone and directly sent these photographs to the GP for digital assessment. Most of these GPs had positive experiences with digital dermatology home consultation, but also reported that not all photographs taken by the patients were of sufficient quality. Therefore, in this thesis it is recommended to improve the digital dermatology platform so that patients and GPs are guided step-by-step with a photo quality checklist or by (video)instructions on how to take photos of sufficient quality and where attention is given to user-friendliness. Subsequently, a quality validation step could, A
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