60 CHAPTER 3 Ksyos declared an average of €64 ($73.08) for a teledermoscopy consultation at a patient’s health insurance company. The weighted mean outpatient healthcare costs in conventional care were €287.43 ($328.25). In total, 12,269 teledermoscopy consultations had responses to Q3 with 3383 Q3 = Yes and 8886 Q3 = No responses. After the teledermoscopy consultation, 72.4% of all patients was not referred (Q3 = No) and with only costs for the teledermoscopy consultation (€64, $73.08). The remaining 27.6% of the patients was referred (Q3 = Yes) after the teledermoscopy consultation with additional (weighted mean) outpatient healthcare costs. This resulted in an average cost estimation of €143.25 ($163.59) for a teledermoscopy patient (Formula 3.1 (Appendix 3.1)). This reflects a cost saving of €144.18 ($164.65; 50.2%) per teledermoscopy patient in comparison with conventional healthcare costs. The time GPs and teledermatologists needed for creating and sending and answering a teledermoscopy consultation respectively, was assessed for 18,619 teledermoscopy consultations with timestamps (performance outcome 7). GPs created and sent 94.8% of the teledermoscopy consultations within one working day (9 hours) with a median time of 5.4 minutes (IQR 6.9, N = 17,660). For 25.3% of the consultations, GPs needed more time than the standard time of 10 minutes for a GP consultation, with 12.4% of the consultations taking longer than 20 minutes. For 962 teledermoscopy consultations (5.2%), GPs needed more than 8 hours to create and send a teledermoscopy consultation. Teledermatologists took a median time of 2.0 minutes (IQR 2.6) to fill in the teledermoscopy consultation form and 75% of all teledermoscopy consultation forms were filled in within 4 minutes. The median response time of teledermatologists was 2.4 hours (mean: 6.7 hours; SD: 22.9 hours; IQR: 6.7 hours; Table 3.5) which decreased over the years. Teledermatologists answered nearly a third of the consultations within one working hour, 80.7% within one working day and 90% of all teledermoscopy consultations within a maximum of two working days (Table 3.2). Table 3.5: Response times of teledermatologists in working hours by year. Year Consultations (N) Mean response time (hr) IQR (hr) Median response time (hr) 2011 80 8.4 7.5 4.8 2012 602 6.6 7.0 2.6 2013 1360 6.0 5.7 2.5 2014 2894 5.6 5.7 2.1 2015 2152 6.7 6.4 2.3 2016 2515 8.0 6.0 2.2 2017 2400 8.0 7.6 2.8 2018 3333 6.4 6.1 2.8 2019 3005 6.1 6.9 2.8 Total 18,341 6.7 6.7 2.4 hr: hour; IQR: inter quartile range.
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