TELEDerm: Implementing store-and-forward teledermatology consultations in general practice: Results of a cluster randomized trial

Abstract

Background Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices. Methods Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices. Results The primary analysis revealed no significant difference in referral rates (relative risk = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates. Conclusions While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.

Digital health interventions in dermatology—Mapping technology and study parameters of systematically identified publications

“…Ideally, this should be done by randomized controlled trials to comprehend the impact on access to care, clinical decisionmaking and outcomes, such as mortality and morbidity. 34,35 While there have been some studies on the effectiveness of S&F teledermatology for diagnostic purposes, 36,37 there is currently only one randomized controlled trial on the effectiveness of AI for image analysis in dermatology. 38 The impact of AI on dermatology and healthcare is increasing, particularly in diagnostic, but also in healthcare communication between patients and dermatologists (as exemplified by ChatGPT).…”

Hybrid care potential of teledermatology: The importance of linking digital and physical practice and acceptance of online services: A cross‐sectional study

“… 4 , 13 , 14 From the users' perspective, when properly implemented, teledermatology can offer advantages such as faster availability of decision‐relevant data, easier access to medical care, better integration of qualified experts, simplified organizational efforts, and increased participation. 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 …”

“…In recent years, numerous teledermatology concepts have emerged that directly provide and bill for services to individuals 4,13,14 . From the users' perspective, when properly implemented, teledermatology can offer advantages such as faster availability of decision‐relevant data, easier access to medical care, better integration of qualified experts, simplified organizational efforts, and increased participation 11,15–21 …”

“…4,13,14 From the users' perspective, when properly implemented, teledermatology can offer advantages such as faster availability of decision-relevant data, easier access to medical care, better integration of qualified experts, simplified organizational efforts, and increased participation. 11,[15][16][17][18][19][20][21] The aim of this study is to explore the potential of teledermatology to close gaps in dermatology care, with a particular focus on patient satisfaction, usage behavior, and preferences. In particular, the importance of linking digital and physical practices in dermatological care will be examined.…”