Medway NHS Foundation Trust, Gillingham, Kent, UK.
Clin Exp Dermatol. 2019 Dec;44(8):874-881. doi: 10.1111/ced.13928. Epub 2019 Feb 14.
There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in-house TD service using store-and-forward technology was set up at a large regional dermatology department in 2004.
To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes.
Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback.
In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face-to-face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance.
We have set up a successful TD service at a UK centre, which has prevented 16 282 face-to-face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
英国发表的有关既定远程皮肤病学（TD）服务的证据很少。2004 年，在一个大型区域皮肤科部门建立了使用存储转发技术的内部 TD 服务。
回顾我们中心的 TD 服务，包括远程咨询次数、诊断编码和患者结果。
使用电子患者数据库，从 2004 年 7 月 31 日至 2018 年 7 月 31 日检索回顾性数据。从患者病历和组织学记录中获取有关患者结果的更详细信息。向 100 名患者分发纸质问卷以获取患者反馈。
在 14 年期间，共进行了 40201 次远程咨询，其中 64%的病例进行了编码（n=25555），其中 77%为病变。最常见的编码病变是良性痣（25%）、脂溢性角化病（22%）和基底细胞癌（19%）。在所有病例中，50%的患者被转介给他们的全科医生进行咨询，34%的患者预约手术，16%的患者预约面对面就诊。在调查中，82%的患者认为该服务“良好”或“非常好”。2015 年 1 月 1 日至 2016 年 1 月 1 日的一项详细研究显示，有 383 名患者（10%）在远程咨询后没有做出诊断，表明诊断存在不确定性。原因包括缺乏诊断特征、恶性肿瘤的可能性和服务因素。在这一队列中，诊断符合率为 68%。
我们在英国的一个中心建立了一个成功的 TD 服务，这在 14 年内避免了 16282 次面对面预约。患者反馈非常好。对诊断不确定的病例进行回顾为服务改进提供了重要信息，这是以前没有记录过的。
