145 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC Facilitators During the pandemic, GPs found digital dermatology care to be reliable, fast, and time efficient (accelerates care delivery). GPs experienced substantive good, practical, and fast responses from the specialists, including adequate diagnoses and treatment recommendations for their patients with skin lesions. GPs found it positive that they themselves remained responsible for the care of their patients. Overall, 26% (17/66) of the GPs indicated that digital care and digital dermatology consultations (partly) replaced physical consultations of their patients in primary and secondary care. A GP reported that he temporarily requested a few more teleconsultations in dermatology during the pandemic, but this number dropped after some time. GPs expressed that they learned from the feedback provided by teledermatologist and for which patient symptoms a teleconsultation is beneficial. Furthermore, a GP reported that the number of digital dermatology consultations that he requested to a dermatologist has decreased because he learned from the feedback from similar previous consultations. Barriers Limited digital photography skills of patients and GPs The first barrier that GPs encountered relates to the limited digital photography skills of GPs and their patients. GPs reported to receive poor or nonassessable photographs from their patients because their patients have poor photography skills as they are not specifically trained in how to take photographs of their skin lesion. More specifically, GPs reported that patients provided skin photographs that were not sharp (when zoomed in), lacked proper details, were blurry or had poor lighting, were taken from a wrong distance, and did not always have good shades of color. In particular, overview, detailed, and magnified photographs of patients’ skin lesions were not optimal, or patients provided an insufficient number of photographs. GPs reported that good web-based support and an understandable guide are needed to ensure good quality of photographs taken by patients; otherwise, their ignorance about how to take pictures will lead to many additional, time-consuming questions from patients to the GP. GPs expressed the need for a quality warning system if images uploaded by a patient are incomplete and not with sufficient quality. Furthermore, approximately half (35/66, 53%) of the GPs indicated that they received complimenting or constructive feedback from a dermatologist about the quality of their photographs. Although most GPs (42/66, 64%) were positive about the provided training, they suggested additional (web-based) training options such as short video instructions as refreshers, practice sessions about photographing skin lesions with their own (dermoscopy) equipment, and advice about using the mobile phone camera. Others do not consider training as necessary to use the service. 7
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