84 CHAPTER 5 ABSTRACT Background Challenges remain for general practitioners (GPs) in diagnosing (pre)malignant and benign skin lesions. Teledermoscopy supports GPs in diagnosing these skin lesions guided by teledermatologists’ (TDs) diagnosis and advice and prevents unnecessary referrals to dermatology care. However, the impact of the availability of teledermoscopy on GPs’ self-reported referral decisions to dermatology care before and after the teledermoscopy consultation is unknown. Objective The objective of this study is to assess and compare the initial self-reported referral decisions of GPs before teledermoscopy versus their final self-reported referral decisions after teledermoscopy for skin lesions diagnosed by the TD as (pre)malignant or benign. Methods Teledermoscopy consultations requested by GPs in daily practice between July 2015 and June 2020 with a TD assessment and diagnosis were extracted from a nationwide Dutch telemedicine database. Based on GP self-administered questions, the GPs’ referral decisions before and their final referral decision after teledermoscopy consultation were assessed for (pre)malignant and benign TD diagnoses. Results GP self-administered questions and TD diagnoses were evaluated for 6364 teledermoscopy consultations (9.3% malignant, 8.8% premalignant, and 81.9% benign skin lesions). In half of the teledermoscopy consultations, GPs adjusted their initial referral decision after TD advice and TD diagnosis. Initially, GPs did not have the intention to refer 67 (56.8%) of 118 patients with a malignant TD diagnosis and 26 (16.0%) of 162 patients with a premalignant TD diagnosis but then decided to refer these patients after the teledermoscopy consultation. Furthermore, GPs adjusted their decision from referral to nonreferral for 2534 (74.9%) benign skin lesions (including 676 seborrheic keratosis and 131 vascular lesions). Conclusions GPs adjusted their referral decision in 52% (n=3306) of the teledermoscopy consultations after the TD assessment. The availability of teledermoscopy is thus of added value and assists GPs in their (non)referral for patients with skin lesions to dermatology care. Teledermoscopy resulted in referrals of patients with (pre)malignant skin lesions that GPs would not have referred directly to the dermatologist. Teledermoscopy also led to a reduction of unnecessary referrals of patients with low-complex benign skin lesions (e.g., seborrheic keratosis and vascular lesions).
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