147 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC perform a biopsy themselves or refer the patient to a dermatologist. However, 6% (4/66) of the GPs indicated to apply digital dermatology care for emergencies and lesions that are suspected to be malignant. Questionnaire improvement Only 4 suggestions for improving the questionnaire were given and 2 support questions were asked. The remaining GPs had no comments or were satisfied with the questionnaire. DISCUSSION Principal findings Overall, GPs had positive experiences with remote digital dermatology care during the COVID-19 pandemic. However, despite these positive perspectives, important barriers of the digital dermatology service were revealed regarding GPs’ and patients’ limited digital photography skills, costs and the lack of appropriate imaging equipment, humancomputer interface and interoperability issues, and different use procedures. Comparison with previous studies Most GPs (46/66, 70%) in our study used the telemedicine platform approximately as often at the time of this study as before the pandemic. In contrast, the Netherlands Institute for Health Services Research (Dutch: Nederlands instituut voor onderzoek van de gezondheidszorg [NIVEL]) reported that 52% of Dutch GP practices intensified their teleconsultation contacts with medical specialists during the first COVID-19 wave, but GPs from these practices considered this only as a slight increase in teleconsultation use [27,28]. Furthermore, studies in other countries showed that dermatologists saw an increase in the number of remote dermatology consultations that they assessed during the pandemic in comparison with that during the prepandemic period [29,30]. Possible reasons for this lack of growth in teleconsultations requested by GPs in our study were, first, the service was already successfully implemented before the pandemic and, second, during the pandemic, patients were not only avoiding hospital care but also GP care. Teledermatology and teledermoscopy had the potential to reduce the number of physical referrals to hospitals but also required the patients to visit the GP’s practice with possible physical contact at <1.5 m (4.9 feet). Patients were still hesitant to physically contact a GP because of the risk of exposure to the virus [1,31]. As a complementary service to the conventional face-to-face dermatology consultation in GP practice, digital dermatology home consultation, which was already in practice, took off. With this service, patients could take the photographs themselves with their own mobile phone or smartphone device and send these photographs securely to the GP for assessment without waiting time, physical contact, and the risk of contamination in GP practice. Therefore, a new group of complaints related to skin disorders that were normally handled physically by the GPs in their practice was submitted digitally by the patient. This meant that the pandemic had changed the spectrum of skin disorders managed and the profile of patients. Digital 7
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