59 ELEVEN YEARS OF TELEDERMOSCOPY IN THE NETHERLANDS Table 3.4. Follow-up of teledermatologists’ advice on patient referral (Q2) by GPs (Q3). Q3 (GP) N Q2 (TD) N Yes 2668 Yes 1439 No 431 NAa 797 Missinga 1 No 5665 Yes 219 No 3271 NAa 2174 Missinga 1 Yes 712 Yes 439 No 110 NAa 163 No 3196 Yes 171 No 2051 NAa 973 Missinga 1 Total 12,241 a Response is excluded from the analysis. GP: general practitioner. Teledermoscopy consultations with missing responses for Q4 and Q5 were excluded from the analysis of quality outcome 4 (N = 6506). GPs reported that they and their patients were helped by the teledermatologists’ response (Q4 = Yes, Some) for 11,901 (97.3%) teledermoscopy consultations. For 11,632 (95.1%) consultations, GPs considered the teledermoscopy consultations as instructive (Q5 = Yes, Some) as they had gained (dermatologic) knowledge. Performance outcomes For 8333 (68.1%) consultations, GPs had the intention to prevent an in-person referral of which 5665 (68.0%) patients actually were not referred after teledermoscopy consultation as reported by the GP (performance outcome 5). Concerning the overall patient referral percentage, GPs indicated that without teledermoscopy they would have referred all 8333 patients (Q1 = Yes), while GPs reported that they actually referred 3380 patients after the teledermoscopy consultation (Q3 = Yes) regardless of their response to Q1 (performance outcome 6). These numbers were compared ((Q3 = Yes) / (Q1 = Yes))*100%) and overall, 40.6% of the patients were referred after the teledermoscopy consultation. And thus, 59.4% of the patients were not referred after the teledermoscopy consultation as reported by the GPs. 3
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