151 GPS’ PERSPECTIVES ABOUT REMOTE DERMATOLOGY CARE DURING THE COVID-19 PANDEMIC feedback, which facilitated the use of the service. This learning curve can be seen as a personal motivator for GPs to apply digital dermatology consultation [11]. Furthermore, this learning curve, in combination with the telemedicine experience level of the GPs before the pandemic, could also have stabilized the number of digital dermatology consultations during the pandemic. In addition, GPs in our study were satisfied with the time-efficient and adequate responses of the dermatologists. A scoping review by Osman et al [51] confirmed that primary care providers’ perspectives about facilitators of digital consultations include obtaining timely responses from specialists and establishing knowledge. Finally, Dutch GPs generally use digital dermatology consultations to prevent physical referrals, if they are unable to determine a differential diagnosis, if the treatment was unsuccessful, or to receive additional advice from the dermatologist. French GPs also use digital dermatology consultation mostly to resolve diagnostic doubts [52]. Furthermore, approximately two-thirds of these French GPs used the service before the pandemic owing to long waiting times for face-to-face dermatology visits, and one-third of the GPs used the service for emergencies [52]. In our study, approximately one-third (21/66, 32%) of the Dutch GPs mentioned long dermatology waiting times as reason for use, and only 2% (1/66) of the GPs used digital dermatology for emergencies. Thus, both Dutch and French GPs indicate that the use of digital dermatology accelerates contact with dermatologists. Table 7.5 shows the sociotechnical considerations for remote digital dermatology. Strengths The first strength of this study was the unique opportunity to evaluate GPs’ perspectives and their experienced facilitators and barriers related to the digital dermatology consultation service during the COVID-19 pandemic, as the service had already been integrated into Dutch general practice before the pandemic. These insights are essential to maintain and optimize the quality of digital dermatology services to the needs of the GPs and to stimulate continuous use of the service in the future. The second strength of this study was the use of a sociotechnical model for the interpretation of the data, which has also been used in other telemedicine and telehealth evaluations [26,53,54]. This subsequently allowed us to identify the GPs’ experienced facilitators and barriers related to digital dermatology care. The added value of this model was that it provided insight into the interrelations between the sociotechnical aspects obtained using the SAF-TSUQ and the additional open-ended insight questions. This model has shown that changes and barriers in one of these sociotechnical aspects directly influence the other aspects. 7
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