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

N. Eminovic; N.F. Keizer; J.C. Wyatt; G. ter Riet; N. Peek; H.C. van Weert; C.A.F.M. Bruijnzeel - Koomen; P.J.E. Bindels

doi:10.1001/archdermatol.2009.44

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

N. Eminovic, N.F. Keizer, J.C. Wyatt, G. ter Riet, N. Peek, H.C. van Weert, C.A.F.M. Bruijnzeel - Koomen, P.J.E. Bindels

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	558-564
Number of pages	7
Journal	Archives of Dermatology
Volume	145
Issue number	5
DOIs	https://doi.org/10.1001/archdermatol.2009.44
Publication status	Published - 2009

Keywords

Adult
Cluster Analysis
Dermatology
Female
Follow-Up Studies
Humans
Male
Middle Aged
Netherlands
Office Visits
Outcome Assessment (Health Care)
Outpatients
Patient Satisfaction
Referral and Consultation
Remote Consultation
Retrospective Studies
Skin Diseases
Surveys and Questionnaires

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10.1001/archdermatol.2009.44

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@article{b38a9057bc804a81bfd6f4ff73be9c17,

title = "Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial",

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.",

keywords = "Adult, Cluster Analysis, Dermatology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Netherlands, Office Visits, Outcome Assessment (Health Care), Outpatients, Patient Satisfaction, Referral and Consultation, Remote Consultation, Retrospective Studies, Skin Diseases, Surveys and Questionnaires",

author = "N. Eminovic and N.F. Keizer and J.C. Wyatt and {ter Riet}, G. and N. Peek and {van Weert}, H.C. and {Bruijnzeel - Koomen}, C.A.F.M. and P.J.E. Bindels",

year = "2009",

doi = "10.1001/archdermatol.2009.44",

language = "English",

volume = "145",

pages = "558--564",

journal = "Archives of Dermatology",

issn = "0003-987X",

publisher = "American Medical Association",

number = "5",

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TY - JOUR

T1 - Teledermatologic consultation and reduction in referrals to dermatologists

T2 - a cluster randomized controlled trial

AU - Eminovic, N.

AU - Keizer, N.F.

AU - Wyatt, J.C.

AU - ter Riet, G.

AU - Peek, N.

AU - van Weert, H.C.

AU - Bruijnzeel - Koomen, C.A.F.M.

AU - Bindels, P.J.E.

PY - 2009

Y1 - 2009

N2 - 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.

AB - 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.

KW - Adult

KW - Cluster Analysis

KW - Dermatology

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Netherlands

KW - Office Visits

KW - Outcome Assessment (Health Care)

KW - Outpatients

KW - Patient Satisfaction

KW - Referral and Consultation

KW - Remote Consultation

KW - Retrospective Studies

KW - Skin Diseases

KW - Surveys and Questionnaires

U2 - 10.1001/archdermatol.2009.44

DO - 10.1001/archdermatol.2009.44

M3 - Article

C2 - 19451500

SN - 0003-987X

VL - 145

SP - 558

EP - 564

JO - Archives of Dermatology

JF - Archives of Dermatology

IS - 5

ER -

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

Abstract

Keywords

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