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To Refer or Not to Refer in Teledermoscopy: Retrospective Study
Esmée Tensen1,2,3, Femke van Sinderen1,2,3, Marcel W Bekkenk4,5
1Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.
JMIR Dermatology
|August 26, 2023
Summary
Teledermoscopy (TDsc) helps general practitioners (GPs) improve skin lesion diagnosis and referral decisions. GPs adjusted their referrals in 52% of cases, leading to more appropriate care for malignant and benign skin lesions.
Area of Science:
- Dermatology
- Medical Informatics
- General Practice
Background:
- General practitioners (GPs) face challenges diagnosing skin lesions.
- Teledermoscopy (TDsc) aids GPs by providing teledermatologist (TD) expertise, potentially reducing unnecessary referrals.
- The impact of TDsc on GP referral decisions before and after consultation was previously unknown.
Purpose of the Study:
- To assess and compare GPs' initial self-reported referral decisions before TDsc versus their final decisions after TDsc.
- To evaluate referral changes for skin lesions diagnosed as malignant, premalignant, or benign by TDs.
Main Methods:
- Retrieved data from a nationwide Dutch telemedicine database (July 2015-June 2020).
- Analyzed 6364 TDsc consultations involving GP referral decisions before and after TD assessment.
- Categorized lesions as malignant, premalignant, or benign based on TD diagnoses.
Main Results:
- GPs adjusted referral decisions in 52% of TDsc consultations.
- Referrals increased for malignant (56.8%) and premalignant (16.0%) lesions GPs initially wouldn't refer.
- Referrals decreased for benign lesions (74.9%), including seborrheic keratosis and vascular lesions.
Conclusions:
- TDsc significantly assists GPs in making appropriate (non)referral decisions for skin lesions.
- TDsc facilitates the referral of potentially malignant cases that might otherwise be missed.
- TDsc reduces unnecessary referrals for benign skin conditions, optimizing dermatology care access.
