School of Medicine, University of Dundee, College of Medicine Dentistry and Nursing, Dundee, UK
Cairnsmore Medical Practice, Dumfries and Galloway, UK.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2021-001789.
Teledermatology is an important subspecialty of telemedicine that continues to evolve with advances in telecommunication and mobile phone technology. A 19-week primary care quality improvement project collected baseline data and tested three change ideas, using the Model for Improvement method, with primary and secondary aims: to increase the weekly percentage of remote dermatological consultations with supporting images that were successfully concluded remotely to greater than 80% and to reduce the weekly percentage of dermatological face-to-face consultations to less than 50%. We hypothesised that by improving the quality of patient images and the confidence of reception staff in triaging skin complaints, there would be a decrease in the weekly number of face-to-face dermatological appointments, thereby decreasing the risk of COVID-19 transmission within the practice and community. Two change ideas focused on supporting patients to improve image quality by introducing '4 Key Instructions' and a patient information leaflet (PIL). The third focused on increasing reception staff confidence in triaging skin complaints by introducing a triage pathway guidance tool. A total of 253 dermatological consultations were analysed: 170 of these were telephone consultations with 308 supporting images. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to an increase in completed remote consultation. Our primary outcome measure was achieved. Our secondary outcome measure suggested that in the absence of high-quality images, it might not be possible to reduce dermatological face-to-face consultations much below 50% in primary care. Process measures showed clear improvements in the quality of images provided by patients which likely contributed to the increase in remote consultation. The implications of these findings for the theory of change are discussed.
远程皮肤病学是远程医疗的一个重要分支，随着电信和移动电话技术的进步，它仍在不断发展。一个为期 19 周的初级保健质量改进项目收集了基线数据，并使用改进模型测试了三个变更思路，其主要和次要目标是：将每周远程皮肤病学咨询的比例提高到 80%以上，其中包括支持远程完成的图像，同时将每周的皮肤科面对面咨询比例降低到 50%以下。我们假设，通过提高患者图像的质量和接待人员对分诊皮肤问题的信心，每周面对面的皮肤科预约数量将会减少，从而降低实践和社区内 COVID-19 传播的风险。两个变更思路专注于通过引入“4 个关键说明”和患者信息传单来支持患者改善图像质量。第三个思路则侧重于通过引入分诊途径指导工具来增加接待人员对分诊皮肤问题的信心。共分析了 253 次皮肤病学咨询：其中 170 次是电话咨询，共提供了 308 张支持图像。过程测量显示，患者提供的图像质量有明显改善，这可能有助于增加远程咨询的完成量。我们的主要结果测量指标得以实现。我们的次要结果测量指标表明，在缺乏高质量图像的情况下，在初级保健中，将皮肤科面对面咨询降低到 50%以下可能不太现实。过程测量显示，患者提供的图像质量有明显改善，这可能有助于远程咨询的增加。这些发现对变革理论的意义进行了讨论。
