Teledermatologisch consult door de huisarts: betere zorg tegen lagere kosten*
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Onderzoek
23-01-2012
Job P. van der Heijden, Nicolette F. de Keizer, Phyllis I. Spuls en Leonard Witkamp

Teledermatological consultation by the general practitioner: better care at lower cost

Objective

To evaluate the effect of teledermatology on efficiency, quality and costs of care following selection in the general practitioner’s practice.

Design

Prospective cohort study.

Method

Teledermatology was used by general practitioners in a self-selected group of patients. Efficiency of care was measured on the basis of decrease in the number of referrals to the dermatologist. Quality was assessed on the basis of the number of teledermatology consultations (TDCs) conducted to obtain advice that resulted in actual referral to the dermatologist, the dermatologist’s response time, the usefulness of the dermatologist’s response, and the educational effect experienced by the general practitioner. Costs of teledermatology and conventional dermatological care were compared on the basis of the percentage of referrals that had been prevented, the average standard charge for a single out-patient visit for the most common diagnoses and the current standard charges for teledermatology.

Results

Between March 2007 and September 2010 TDCs were conducted by 1,821 general practitioners and 166 dermatologists; 37,207 TDCs were included in this study. The most commonly diagnosed abnormalities were eczema, infectious conditions and benign tumours. In cases where teledermatology was used to prevent a physical referral (n = 26,596), 74% of referrals to the dermatologist were actually prevented. 10,611 TDCs were conducted in order to obtain advice; 16% of these resulted in a physical referral to the dermatologist. In the total population 68% of referrals were prevented by TDCs. The mean dermatologist response time was 4.6 hours. General practitioners experienced an educational effect in 86% of the TDCs, and 88% found the dermatologist’s response to be useful. The estimated cost reduction was 18%.

Conclusion

Teledermatology contributed to an improvement in dermatological care at lower cost. We are therefore of the opinion that teledermatology deserves a place as a new referral pathway to secondary care.

Conflict of interest: J.P. van der Heijden is employed by the KSYOS telemedical centre; L. Witkamp is a director of the KSYOS telemedical centre; Ph. Spuls received financial support for research from the Netherlands Institute for Health Research and Development (ZonMW), Schering Plough, the Dutch Society for Dermatology and Venereology (NVDV) and the National Psoriasis Foundation (NPF); the institute that employs Ph. Spuls received financial support for consultation from Leo-pharma. Financial support for this article: none declared.