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Arch Dermatol. 2009 May;145(5):558-64. doi: 10.1001/archdermatol.2009.44.

Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial.

Author information

  • 1Department of Medical Informatics, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, the Netherlands. eminovic@gmail.com

Abstract

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.

PMID:
19451500
[PubMed - indexed for MEDLINE]
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