57 ELEVEN YEARS OF TELEDERMOSCOPY IN THE NETHERLANDS Experience of GPs and teledermatologists with teledermoscopy was taken into account in analyzing the time GPs and teledermatologists needed to perform a teledermoscopy consultation. The experience was defined as the number of teledermoscopy consultations previously performed by a GP or teledermatologist. A linear regression model was used to assess the impact of GP’s and teledermatologist’s experience on the time GPs and teledermatologists had needed to create and send or answer a teledermoscopy consultation respectively (with p < 0.05 as significant). RESULTS A total of 18,738 teledermoscopy consultations were performed from the first teledermoscopy consultation on 26 February 2009 to the last data extraction on 5 February 2020. These consultations were sent by 1341 GPs working in 953 practices and assessed by 158 teledermatologists. Results regarding the teledermoscopy quality and performance outcomes are summarized in Figure 3.1 and Table 3.2. Table 3.2: Overview of the outcomes on the teledermoscopy quality and performance outcomes. Teledermoscopy quality outcomes of the teledermoscopy consultations: 1. 31.9% was extra requested by GP due to the availability of teledermoscopy, to get dermatological advice. 2. 18.2% led to in-person referrals of patients otherwise not referred by the GP, these included teledermoscopy diagnosis of skin cancer. 3. GPs follow the teledermatologists’ advice on patient referral in 88.5% of all teledermoscopy consultations. 4. 97.3% was reported as helpful by the GP and 95.1% was considered instructive. Teledermoscopy performance outcomes of the teledermoscopy consultations: 5. 68.0% was not referred after the teledermoscopy consultation, while the GP indicated to refer these patients if teledermoscopy was not available. 6. Overall 59.4% of all patients were not referred after the teledermoscopy consultation. 7. The GP needed 5.4 minutes to create and send a teledermoscopy consultation, the teledermatologist needed 2.0 minutes to fill in the teledermoscopy consultation (median times), the teledermoscopy response time was 2.4 hours (median). GP: general practitioner. Quality outcomes Of the 18,738 assessed teledermoscopy consultations, 12,241 had responses to both Q1 and Q3, and 3908 (31.9%) out of these 12,241 teledermoscopy consultations were considered as a second opinion request by the GP (Table 3.3) (quality outcome 1; Q1 = No). 3
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