Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial
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Published on: September 26, 2019
Nina Eminović1, Nicolette F de Keizer, Jeremy C Wyatt
1Department of Medical Informatics, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, the Netherlands. eminovic@gmail.com
Objective:
To determine whether teledermatologic consultations can reduce referrals to a dermatologist by general practitioners (GPs).
Design:
Multicenter cluster randomized controlled trial.
Setting And Participants:
We recruited 85 GPs from 35 general practices in 2 regions in the Netherlands (Almere and Zeist); 5 dermatologists from 2 nonacademic hospitals were also included in the study. Interventions The GPs randomized to the intervention used a teledermatologic consultation system to confer with a dermatologist, whereas those in the control group referred their patients according to usual practice. All patients, regardless of their condition, were seen in the office by a dermatologist after approximately 1 month.
Outcome Measures:
The main outcome measure was the proportion of office visits prevented by teledermatologic consultation, as determined by dermatologists at approximately the 1-month office visit. The secondary outcome measure was patient satisfaction, measured using the Patient Satisfaction Questionnaire III developed by Ware et al.
Results:
The 85 study GPs enrolled 631 patients (46 intervention GPs, 327 patients; 39 control GPs, 304 patients). The 5 dermatologists considered a consultation preventable for 39.0% of patients who received teledermatologic consultation and 18.3% of 169 control patients, a difference of 20.7% (95% confidence interval, 8.5%-32.9%). At the 1-month dermatologist visit, 20.0% of patients who received teledermatologic consultation had recovered compared with 4.1% of control patients. No significant differences in patient satisfaction were found between groups.
Conclusions:
Teledermatologic consultation offers the promise of reducing referrals to a dermatologist by 20.7%. Providing teledermatologic consultation by GPs with more extended knowledge of dermatology may further reduce the need for dermatologist referrals. Trial Registration Current Controlled Trials No. ISRCTN57478950.
