183 GENERAL DISCUSSION was sent to 2179 healthcare providers for validation. Psychometric analysis of the questionnaire items revealed six reliable scales: training, communication, organization policy and strategy, interaction telemedicine platform, use of telemedicine platform, and working conditions. In Chapter 7 we used this SAF-TSUQ questionnaire to examine experiences of Dutch GPs with teledermatology, teledermoscopy and dermatology home consultation from a contracted telemedicine organization perspective. In addition, we studied digital dermatology care as experienced by GPs from a broad sociotechnical perspective. We extended the SAF-TSUQ questionnaire with in-depth insight questions (for example, about training and photo quality) and with questions related to the impact of the COVID19 pandemic on the use of digital dermatology care in general practice. With this extended version we investigated the sociotechnical facilitators and barriers that GPs came across in teledermatology, teledermoscopy and dermatology home consultation during the pandemic in the Netherlands. In the analyses of the data, we applied the 8-dimensional sociotechnical model by Sittig and Singh [1] to find interrelations between the sociotechnical aspects of the SAF-TSUQ and responses to the additional openended questions. We found that GPs were generally satisfied with the existing storeand-forward digital dermatology service, platform, and telemedicine organization during the pandemic. In addition, these analyses showed that despite digital dermatology services being used for years, GPs also experienced critical interrelated barriers in the use of digital dermatology care that limited the full potential and use of these dermatology services. These barriers included limited digital photography skills of GPs, costs and lack of appropriate photography equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service. Furthermore, 15% of the GPs provided dermatology home consultation to patients during the pandemic, which meant that patients took photographs of their skin complaints with their own smartphone and sent these photographs directly to the GP for digital assessment. Most of these GPs had positive experiences with this service but also mentioned that not all photographs taken by the patients were of sufficient quality. GPs indicated that dermatology home consultation is appropriate for skin conditions with red discoloration, nevi, bumps, wounds, and diaper rash. Furthermore, these GPs had no clear preference regarding the age group of patients who could perform the dermatology home consultation themselves. Practical implications and recommendations for practice Integral Care Agreement (IZA) The Dutch Ministry of Public Health, Welfare and Sport and various organizations across the entire spectrum of healthcare, have established the Dutch Integral Care Agreement (Dutch: Integraal Zorg Akkoord (IZA)) with the aim of improving the sustainability of the health care system [2]. In this agreement, healthcare organizations indicate how to deal 8
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