211 APPENDICES The main conclusion of this thesis is that teledermatology and teledermoscopy are of added value for GPs in general practice. This thesis confirms that these services save healthcare costs and patient travel and wait time compared to conventional dermatology care. Furthermore, in half of the teledermoscopy consultations, GPs changed their initial referral decision after teledermatologist assessment. Teledermoscopy supports GPs thus in deciding whether a referral to the dermatologist is necessary for patients with skin lesions suspected of malignancy as well as for patients with low-complex, benign skin lesions. In addition, GPs slightly improved their dermatology knowledge and expertise in diagnosing skin lesions over time and they considered the provided teledermatologist responses helpful and instructive. In spite of these advantages, there are several barriers that impede the use and full potential of the digital dermatology services in Dutch general practice. These barriers need to be addressed to further increase the use of the digital dermatology services. Barriers found in this thesis include GPs’ and patients’ limited photography skills, the costs and lack of appropriate photography equipment, the humancomputer (users) interface and interoperability issues on the platform, and differences in use procedures in practice. These sociotechnical barriers are interrelated and influence each other. Therefore, various adjustments in the entire digital dermatology process and platform are needed to further improve and scale up these services in GP practices. To realize sustainable digital dermatology services, the future corresponding care path should be co-created together with GPs, dermatologists, patients, health insurance companies, government policy makers and patient advocacy organizations. Moreover, future studies should, for example, focus on patients’ and dermatologists’ perspectives on these (enhanced) services and on the use and merits of AI applications. A
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