32 CHAPTER 2 with publication year before 2011. First, all titles were scanned and all duplicates were removed. Titles that contained “teledermatology” or had a relevant focus were included. Secondly, titles and abstracts were scanned and included if they met the review questions. All papers without an abstract were scanned quickly and were included if they focused on teledermatology. Unavailable publications and publications focusing solely on teledermatopathology were excluded. Finally, one reviewer read all remaining publications and completed a data abstraction form with publication characteristics and relevance for every publication. Results discussed in this review were based on this final selection of the publications and any additional publications that were cited in one of the publications and met the inclusion criteria, but were not in the original search result. SEARCH RESULTS The literature search, as conducted in November 2015, resulted in 787 references and after removal of the duplicates 430 unique publications remained. After title selection, 265 publications were included for abstract selection and 114 publications were included for full text reading. Furthermore, 60 (systematic) reviews, published before 2011 were found and 14 of those reviews remained for full reading after title and abstract selection. Actors There are different instances of teledermatology in which actors are involved. An overview of different actors in teledermatology is presented in Figure 2.1. Primary teledermatology includes direct communication between the patient and the primary healthcare provider (i.e., general practitioner (GP), general nurse) or dermatologists for first diagnosis or referral [6]. Most common is secondary teledermatology. Patients visit the GP and the GP communicates or exchanges medical information of the patient with the dermatologist. Secondary teledermatology is used by primary care providers to receive advice for triage of patients and consults [6]. Other secondary actors who are not explicitly mentioned in the literature are health insurance companies and healthcare institutions, e.g., burn care centers, nursing homes, and emergency departments. Tertiary teledermatology concerns the collaboration and communication among dermatologists [13]. Finally, patient-assisted teledermatology is a form of teledermatology in which the patient interacts directly with a healthcare professional, for example in follow-up care in which the patient interacts with a (public health) nurse or wound-care nurse.
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