189 GENERAL DISCUSSION teledermoscopy consultations, the largest teledermoscopy study ever performed in the Netherlands. Furthermore, in contrast to other studies, our studies included data on patients that GPs would not have referred to the dermatologist without the availability of digital dermatology care and patients that GPs would have referred without the digital dermatology service. The third strength of the studies in this thesis is that we followed a structured approach to develop and validate the SAF-TSUQ instrument (Chapter 6). In the past, various instruments have been designed to gauge healthcare providers’ satisfaction with telemedicine, but most of these instruments focused on privacy, ease of use, usefulness, image quality, acceptance, or technical evaluation of a telemedicine system [30]. The SAF-TSUQ is unique because this questionnaire focuses on telehealth usability and job satisfaction in healthcare settings and combines telemedicine platform and contracted telemedicine organization related items. Subsequently, we extended this SAF-TSUQ questionnaire with some additional open and closed-ended questions to examine GPs experiences with digital dermatology care from a sociotechnical perspective. Since the service had already been implemented into Dutch GP practice before the COVID-19 pandemic, we had a unique opportunity to investigate facilitators and barriers that GPs encountered in teledermatology, teledermoscopy and dermatology home consultation during the pandemic in the Netherlands (Chapter 7). Limitations The first limitation of our research is the lack of clinical follow-up data from patients who received a teledermoscopy consultation. This restricted our insight into the number of additional patient referrals that took place after the initial teledermoscopy consultation, and thus in types of patients who GPs initially not referred based on the teledermoscopy consultation. Furthermore, for patients referred after teledermoscopy, we lacked data of the dermatologist face-to-face or histopathology confirmed diagnoses in dermatology practice. This is, among other factors, owing to the retrospective character of our studies and interoperability and privacy restrictions of data exchange between the relevant electronic patient records. The lack of data on these diagnoses hindered us in comparing final confirmed face-to-face or histopathological diagnoses with initial TD diagnoses of patients’ skin lesions. In addition, we also missed the face-to-face or histopathology confirmed diagnoses of patients not referred after teledermoscopy. Although two studies in the literature used a follow-up procedure to verify benign lesions, referring patients with apparently benign skin lesions to the dermatologist and collecting histopathology simply for research purposes has been perceived as unethical and leads to resistance by GPs and patients [17]. Therefore, in our retrospective studies, the patient diagnoses given by the TDs were used as final diagnosis outcomes. Another limitation of this thesis is that all studies were conducted in the Netherlands and that we had only access to the store-and-forward digital dermatology consultation data of 8
RkJQdWJsaXNoZXIy MTk4NDMw