58 CHAPTER 3 Table 3.3: Responses to GP evaluation questions Q1, Q3, Q4 and Q5 for consultations with responses to all evaluation questions. Number of consultations (%) Teledermoscopy referral percentage (Q1 = Yes) 8333 (68.1) Referred (Q3 = Yes) 2668 (32.0) Not referred (Q3 = No) 5665 (68.0) Requesting dermatologic advice (Q1 = No) 3908 (31.9) Referred (Q3 = Yes) 712 (18.2) Not referred (Q3 = No) 3196 (81.8) Helpful response (Q4 = Yes, Some) 11,901 (97.3) Instructive (Q5 = Yes, Some) 11,632 (95.1) GP: general practitioner. Of the 3908 patients that would not have been referred by the GP without teledermoscopy, 712 (18.2%) patients were physically referred to a dermatologist after the teledermoscopy consultation (quality outcome 2; Q1 = No AND Q3 = Yes) (Table 3.3). These referrals were defined as extra teledermoscopy referrals. The teledermatologist provided an ICD-10 code for 458 of these consultations since July 2015, including skin cancer teledermoscopy diagnoses. Three consultations with missing responses and 4107 (33.6%) consultations for which the teledermatologist responded “NA” (Q2) were excluded from the analysis. The GP followed up on the teledermatologist’s advice on patient referral (quality outcome 3; (Q2 = Q3) / (Q2 = Yes OR Q2 = No) (Table 3.4) for 88.5% (N = 8313) of the 12,241 teledermoscopy consultations. Eight out of 30 teledermatologists with years of teledermoscopy expertise in assessing teledermoscopy consultations participated in the email questionnaire inquiring them on the reasons why teledermatologists could have responded “NA” on Q2 instead of “No” or “Yes” in the system. Teledermatologists reported that they preferred the “NA” response when they would like to write their advice on referral management of the patient in free text. They preferred to leave the final referral decision up to the GP, for example, when skin lesion photos were of poor quality.
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