Leggett P, Gilliland A E W, Cupples M E, McGlade K, Corbett R, Stevenson M, O'Reilly D, Steele K
Department of General Practice, Queen's University, Royal Victoria Hospital, Belfast, UK.
Fam Pract. 2004 Feb;21(1):54-6. doi: 10.1093/fampra/cmh112.
Fifteen percent of GP consultations are for dermatological conditions; 4% of these are referred to a dermatologist. There are long waiting lists for dermatology appointments. This study examines the value of instant photography in managing dermatology referrals.
The purpose of our study was to compare outcomes of referral for dermatology appointments between patients whose referral letters do or do not include instant photograph(s).
Patients (136), referred to a dermatologist by GPs in two urban health centres, were randomly allocated to study and control groups. Instant photographs, taken by the GP, were included in the referral letters. Control group patients were given out-patient appointments in the usual way. The numbers of study group patients needing an appointment for diagnosis or management and with a changed diagnosis after face-to-face consultation were recorded. Waiting time from referral to appointment or management plan was recorded for both groups.
For 63% of the study group (45/71), a diagnosis and a management plan were made without the patient requiring an appointment. This included 38% (27/71) who, after diagnosis and initial management, needed an appointment and 25% (18/71) who did not. The remainder of the study group (37%; 26/71) required a face-to-face consultation. The mean time for formulation of a management plan for patients without an appointment was 17 days (SD = 11); waiting times for appointments in study and control groups were similar (mean 55 days; SD = 40).
Instant photography is helpful in managing dermatology referrals and offers the potential to reduce numbers requiring an out-patient appointment by 25%.
15%的全科医生会诊是针对皮肤病问题；其中4%的患者会被转诊至皮肤科医生处。皮肤科预约等候名单很长。本研究探讨即时摄影在处理皮肤科转诊中的价值。
我们研究的目的是比较转诊信中包含或不包含即时照片的患者转诊至皮肤科预约的结果。
在两个城市健康中心由全科医生转诊至皮肤科医生的136名患者被随机分配至研究组和对照组。全科医生拍摄的即时照片被纳入转诊信中。对照组患者按常规方式进行门诊预约。记录研究组中需要预约进行诊断或治疗以及面对面会诊后诊断发生改变的患者数量。记录两组从转诊到预约或治疗计划的等待时间。
研究组中63%（45/71）的患者在无需预约的情况下就做出了诊断和治疗计划。这包括38%（27/71）在诊断和初步治疗后需要预约的患者以及25%（18/71）无需预约的患者。研究组其余患者（37%；26/71）需要面对面会诊。无需预约的患者制定治疗计划的平均时间为17天（标准差 = 11）；研究组和对照组的预约等待时间相似（平均55天；标准差 = 40）。
即时摄影有助于处理皮肤科转诊，有可能将需要门诊预约的人数减少25%。
