Departments of Dermatology Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Br J Dermatol. 2011 Nov;165(5):1058-65. doi: 10.1111/j.1365-2133.2011.10509.x.
Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed.
This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP).
Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology.
One thousand, eight hundred and twenty GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included. In the group of patients where the GP used teleconsultation to prevent a referral (n =26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n =10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4·6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%.
Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care.
远程皮肤病学是远程医疗在皮肤病学领域的应用，其准确性和可靠性与实体皮肤病学相似。自 2005 年以来，远程皮肤病学在荷兰的日常实践中得到了广泛应用，并得到了全额报销。
本研究前瞻性调查了在日常实践中整合远程皮肤病学并由全科医生（GP）进行患者选择后，对护理效率、质量和成本的影响。
在荷兰的日常 GP 实践中，由 GP 和区域皮肤科医生进行远程皮肤病学咨询。通过减少向皮肤科医生进行物理转诊的数量来衡量护理效率。通过第二次咨询的远程咨询百分比、这些远程咨询产生的物理转诊、皮肤科医生的响应时间以及 GP 所经历的教育效果来衡量护理质量。将没有远程皮肤病学的常规医疗保健成本与有远程皮肤病学的成本进行比较。
1820 名全科医生和 166 名皮肤科医生进行了远程皮肤病学，2007 年 3 月至 2010 年 9 月共进行了 37207 次远程咨询。在 GP 使用远程咨询来预防转诊的患者组（n=26596）中，74%的物理转诊得到了预防。在 GP 用于二次咨询的患者组（n=10611）中，16%的患者在远程咨询后进行了物理转诊。总人群中的预防转诊率为 68%。皮肤科医生的平均响应时间为 4.6 小时（中位数为 2.0）。85%的 GP 表示远程咨询具有有益的教育效果。估计成本降低了 18%。
远程皮肤病学可能可以提高效率，同时降低成本。因此，我们认为，在 GP 选择后，应考虑将远程皮肤病学作为向二级保健转诊的可能途径。
