Value of Teledermoscopy in Primary Healthcare Centers: Preliminary Results of the TELESPOT Project in Belgium

Advancing Dermatological Care: A Comprehensive Narrative Review of Tele-Dermatology and mHealth for Bridging Gaps and Expanding Opportunities beyond the COVID-19 Pandemic

Mobile health (mHealth) has recently had significant advances in tele-dermatology (TD) thanks to the developments following the COVID-19 pandemic. This topic is very important, as telemedicine and mHealth, when applied to dermatology, could improve both the quality of healthcare for citizens and the workflow in the health domain. The proposed study was centered on the last three years. We conducted an overview on the opportunities, the perspectives, and the problems involved in TD integration with mHealth. The methodology of the narrative review was based on: (I) a search of PubMed and Scopus and (II) an eligibility assessment, using properly proposed parameters. The outcome of the study showed that during the COVID-19 pandemic, TD integration with mHealth advanced rapidly. This integration enabled the monitoring of dermatological problems and facilitated remote specialist visits, reducing face-to-face interactions. AI and mobile apps have empowered citizens to take an active role in their healthcare. This differs from other imaging sectors where information exchange is limited to professionals. The opportunities for TD in mHealth include improving service quality, streamlining healthcare processes, reducing costs, and providing more accessible care. It can be applied to various conditions, such as (but not limited to) acne, vitiligo, psoriasis, and skin cancers. Integration with AI and augmented reality (AR), as well as the use of wearable sensors, are anticipated as future developments. However, integrating TD with mHealth also brings about problems and challenges related to regulations, ethics, cybersecurity, data privacy, and device management. Scholars and policymakers need to address these issues while involving citizens in the process.

General Practitioners' Perspectives About Remote Dermatology Care During the COVID-19 Pandemic in the Netherlands: Questionnaire-Based Study

BACKGROUND

The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period.

OBJECTIVE

We investigated GPs' perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach.

METHODS

In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model.

RESULTS

In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs' and patients' limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service.

CONCLUSIONS

Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality.

Lead Time from First Suspicion of Malignant Melanoma in Primary Care to Diagnostic Excision: a Cohort Study Comparing Teledermatoscopy and Traditional Referral to a Dermatology Clinic at a Tertiary Hospital

INTRODUCTION

The increasing use of teledermatoscopy in clinical practice has led to demands to evaluate the effects of this new technology on traditional healthcare systems.

OBJECTIVES

To study lead times from first consultation in primary care to diagnostic excision of suspected malignant melanoma lesions in traditional referrals to a tertiary hospital-based dermatology clinic compared with mobile teledermatoscopy referrals.

METHODS

A retrospective cohort study design was used. Data on sex, age, pathology, caregivers, clinical diagnosis, date for first visit to primary care unit, and date for diagnostic excision were collected from medical records. Patients managed through traditional referral (n=53) were compared with patients managed at primary care units using teledermatoscopy (n=128) regarding lead time from first visit to diagnostic excision.

RESULTS

Mean time from date of first visit at primary care unit to diagnostic excision did not differ between the traditional referral and teledermatoscopy groups (16.2 vs. 15.7 days, median 10 vs. 13 days, p=0.657). Lead times from date of referral to diagnostic excision did not significantly differ (15.7 vs. 12.8 days, median 10 vs. 9 days, p=0.464).

CONCLUSIONS

Our study indicates that lead time to diagnostic excision for patients with suspected malignant melanoma managed by teledermatoscopy was comparable and not inferior to that of the traditional referral pathway. If teledermatoscopy is used at first consultation in primary care, it could potentially be more efficient than traditional referral.

To Refer or Not to Refer in Teledermoscopy: Retrospective Study

BACKGROUND

Challenges remain for general practitioners (GPs) in diagnosing (pre)malignant and benign skin lesions. Teledermoscopy (TDsc) supports GPs in diagnosing these skin lesions guided by teledermatologists' (TDs) diagnosis and advice and prevents unnecessary referrals to dermatology care. However, the impact of the availability of TDsc on GPs' self-reported referral decisions to dermatology care before and after the TDsc consultation is unknown.

OBJECTIVE

The objective of this study is to assess and compare the initial self-reported referral decisions of GPs before TDsc versus their final self-reported referral decisions after TDsc for skin lesions diagnosed by the TD as (pre)malignant or benign.

METHODS

TDsc consultations requested by GPs in daily practice between July 2015 and June 2020 with a TD assessment and diagnosis were extracted from a nationwide Dutch telemedicine database. Based on GP self-administered questions, the GPs' referral decisions before and their final referral decision after TDsc consultation were assessed for (pre)malignant and benign TD diagnoses.

RESULTS

GP self-administered questions and TD diagnoses were evaluated for 6364 TDsc consultations (9.3% malignant, 8.8% premalignant, and 81.9% benign skin lesions). In half of the TDsc consultations, GPs adjusted their initial referral decision after TD advice and TD diagnosis. Initially, GPs did not have the intention to refer 67 (56.8%) of 118 patients with a malignant TD diagnosis and 26 (16.0%) of 162 patients with a premalignant TD diagnosis but then decided to refer these patients after the TDsc consultation. Furthermore, GPs adjusted their decision from referral to nonreferral for 2534 (74.9%) benign skin lesions (including 676 seborrheic keratosis and 131 vascular lesions).

CONCLUSIONS

GPs adjusted their referral decision in 52% (n=3306) of the TDsc consultations after the TD assessment. The availability of TDsc is thus of added value and assists GPs in their (non)referral for patients with skin lesions to dermatology care. TDsc resulted in referrals of patients with (pre)malignant skin lesions that GPs would not have referred directly to the dermatologist. TDsc also led to a reduction of unnecessary referrals of patients with low complex benign skin lesions (eg, seborrheic keratosis and vascular lesions).