Department of Medical Informatics, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Public Health, Digital Health, Amsterdam, Netherlands.
JMIR Dermatol. 2024 Jul 26;7:e56723. doi: 10.2196/56723.
Despite the global upscale of teledermatology during the COVID-19 pandemic, persistent barriers, such as the poor anamnesis and photo quality, hinder its effective use in practice. Understanding Dutch dermatologists' experiences and satisfaction with using the teledermatology system in the Dutch health care system is needed. A holistic evaluation may provide valuable insight to understand how barriers interrelate which is deemed necessary for the innovation of teledermatology in practice.
Guided by a complex adaptive system perspective, this study aims to understand Dutch dermatologists' experience and satisfaction with their training, support communication, interaction, and usage of a teledermatology platform of a Dutch digital hospital during the COVID-19 pandemic, uncovering insights to improve teledermatology services for the future.
A web-based questionnaire was sent in December 2021 to Dutch dermatologists who (1) had an active teledermatology platform account, and (2) responded to a teledermatology consultation between October 1, 2019, and September 30, 2021. The questionnaire consisted of the validated Store-and-Forward Telemedicine Service User-satisfaction Questionnaire (SAF-TSUQ) questionnaire, and new questions regarding; demographics of teledermatologists, the use of teledermatology during the COVID-19 pandemic, the performance of teledermatology by general practitioners (GP), and the role of dermatologists in the teledermatology process. The open-ended questions were analyzed by a grounded theory approach guided by a sociotechnical model and complemented by a complex adaptive system perspective. A panel discussion with 3 dermatologists was performed to provide additional insight into the responses to the questionnaire.
We obtained responses from 25 out of the 249 (10%) invited dermatologists. Overall, dermatologists had a positive experience with teledermatology. Interestingly, teledermatology use frequency remained unaffected by the COVID-19 pandemic. However, the insufficient quality and incompleteness of the clinical content (photos and anamneses information) of the teledermatology consultation impacted the efficiency of the teledermatology workflow. Dermatologists expressed the need for improvement to avoid time-consuming processes or physical referrals. The panel discussion enriched and confirmed the responses, suggesting solutions like mandatory fields for the GPs for a complete anamnesis.
Dutch Dermatologists view teledermatology as a valuable tool to provide access to dermatology care. However, improvements regarding the quality and completeness of the provided clinical content are necessary for the effectiveness and efficiency of the complex teledermatology system in Dutch health care. This could increase both the dermatologists' satisfaction and the quality of teledermatology services. Managing trade-offs, such as time investments versus image quality, is crucial for teledermatology implementation and should be assessed from a complexity perspective to understand trade-offs and prevent unintended consequences.
尽管在 COVID-19 大流行期间全球范围内采用了远程皮肤病学，但较差的病史和照片质量等持续存在的障碍阻碍了其在实践中的有效使用。了解荷兰皮肤科医生在荷兰医疗保健系统中使用远程皮肤病学系统的经验和满意度是必要的。全面评估可以提供有价值的见解，以了解障碍如何相互关联，这对于实践中远程皮肤病学的创新是必要的。
本研究以复杂适应系统的观点为指导，旨在了解荷兰皮肤科医生在 COVID-19 大流行期间接受培训、支持沟通、互动和使用荷兰数字医院的远程皮肤病学平台的经验和满意度，为未来的远程皮肤病学服务提供改进的见解。
2021 年 12 月，向（1）拥有活跃的远程皮肤病学平台账户和（2）在 2019 年 10 月 1 日至 2021 年 9 月 30 日期间回复远程皮肤病学咨询的荷兰皮肤科医生发送了一份基于网络的问卷。该问卷包括经过验证的存储转发远程医疗服务用户满意度问卷（SAF-TSUQ），以及关于以下方面的新问题：远程皮肤病学医生的人口统计学特征、COVID-19 大流行期间远程皮肤病学的使用情况、全科医生（GP）进行远程皮肤病学的表现以及皮肤科医生在远程皮肤病学过程中的角色。对开放式问题进行了扎根理论分析，该分析由社会技术模型指导，并辅以复杂适应系统的观点进行补充。与 3 名皮肤科医生进行了小组讨论，以提供对问卷答复的额外见解。
我们从 249 名受邀皮肤科医生中获得了 25 名（10%）的回复。总体而言，皮肤科医生对远程皮肤病学有积极的体验。有趣的是，远程皮肤病学的使用频率并未受到 COVID-19 大流行的影响。然而，远程皮肤病学咨询的临床内容（照片和病史信息）的质量和完整性不足，影响了远程皮肤病学工作流程的效率。皮肤科医生表示需要改进以避免耗时的流程或物理转诊。小组讨论丰富并证实了答复，建议为全科医生设置必填字段以提供完整的病史。
荷兰皮肤科医生认为远程皮肤病学是提供皮肤病学护理的有价值的工具。然而，为了提高复杂远程皮肤病学系统在荷兰医疗保健中的有效性和效率，有必要改进提供的临床内容的质量和完整性。这可以提高皮肤科医生的满意度和远程皮肤病学服务的质量。从复杂性的角度评估权衡，例如时间投入与图像质量，对于远程皮肤病学的实施至关重要，以了解权衡并防止意外后果。
