John de Heide

Smartphone photography by patients in telemedical wound assessment 155 depicted in Table 1. Patients who participated in the study were younger and had less comorbidity (eg, diabetes, rheumatism) than nonparticipants. Of these 46 patients, 5 were excluded from participation because of a prolonged clinical stay (96 days), miscommunication, or cancellation of their procedure, and 1 patient was lost to follow-up. Consequently, the final study population included 40 patients of whom 29 patients had a smartphone and 11 patients had a feature phone. Participants expressed a positive attitude regarding the studied intervention, especially smartphone users. Feature phone users, however, were doubtful whether they were able to provide the pictures as requested. In addition, some family members/caregivers of smartphone users offered to help, even if they had to visit the patient extra for it. Most participants (n = 33, 83%) were able to upload their pictures after hospital discharge. Importantly, patients with a smartphone were more successful in uploading pictures in comparison with patients with a feature phone (93% vs 55%, P < .01). Examples can be seen in Figures 2 and 3. During this pilot study, a total of 102 pictures were transmitted. Most pictures (88%) were considered to be of sufficient quality for interpretation. According to the predefined criteria, the agreement between the 2 independent investigators in assessment of the pictures was between 93% and 97%. Interobserver agreement was good, as depicted in Table 2. The results of the questionnaire are presented in Table 3. Overall, 32 patients (80%) returned the questionnaire. More than half of these patients indicated that they made the photo with some help. Importantly, most smartphone users were able to send the photo and indicated this as easy, whereas feature phone users more often experienced technical issues (63% vs 13%, P <.01). Overall, smartphone and feature phone users had a positive attitude toward making pictures as part of post discharge care (88% and 75%, respectively). When focusing on the preferred mode of contact, 71% of the smartphone users preferred a telephonic consultation in combination with uploading photos, as compared with 38% of the feature phone users. Fifty percent of the feature phone users preferred a hospital visit, whereas for smartphone users, this was only 8%. 9

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