Hernström Nils, Ingvar Åsa
Dermatology and Venereology, Department of clinical sciences, Lund University Skin Cancer research group (LuScaR), Lund University, Skåne University Hospital, Raffinadgatan 4, Lund, 222 35, Sweden.
Måsen Primary Health Care Center, Lund, Sweden.
BMC Prim Care. 2024 Dec 17;25(1):417. doi: 10.1186/s12875-024-02678-w.
Teledermatoscopy (TDS) has proven to be effective and reliable for diagnosis of skin malignancies. The factors that determine the success of implementation of TDS are largely unknown.
To investigate barriers to implementation of TDS in primary health care (PHC) at center and individual level.
Following introduction of TDS, cross-sectional quantitative data and free text comments were collected by surveys sent to PHC centers and PCH practitioners. Successful implementation was defined as regularly sent cases at center level and self-reported usage at individual level. Factors associated with implementation were evaluated with Chi-square, Kruskal-Wallis test and logistic regression.
93/117 (78.2%) of PHC centers and 239/725 (32.9%) of PHC practitioners answered the surveys. 54.8% (n = 51) of PHC centers and 64.3% (n = 153) of PHC practitioners had implemented TDS. There was a strong association between hardware arrival before introduction and TDS usage at center level (OR 6.0; 95% CI 1.5-24.3). At individual level, male sex was positively associated with usage (OR 1.9; 95%, CI 1.0-3.4), and for every year of increased age, the chance of using TDS decreased with 3% (OR 1.0, 95% CI 0.9-1.0). No other factor was associated with implementation. "Good" was the most common overall impression (54.8%), and the majority found no problems using the system (> 85%). The most common complaint was technical issues followed by no added value.
Successful implementation of TDS was strongly associated with hardware arrival at center level, and to male sex and younger age at individual level. Satisfaction was overall high.
皮肤镜检查（TDS）已被证明在皮肤恶性肿瘤的诊断中有效且可靠。然而，决定TDS实施成功的因素在很大程度上尚不清楚。
在中心和个体层面调查基层医疗保健（PHC）中TDS实施的障碍。
引入TDS后，通过向PHC中心和PCH从业者发送调查问卷收集横断面定量数据和自由文本评论。成功实施定义为中心层面定期发送病例和个体层面自我报告的使用情况。使用卡方检验、Kruskal-Wallis检验和逻辑回归评估与实施相关的因素。
93/117（78.2%）的PHC中心和239/725（32.9%）的PHC从业者回复了调查问卷。54.8%（n = 51）的PHC中心和64.3%（n = 153）的PHC从业者实施了TDS。引入前硬件设备的到位与中心层面TDS的使用之间存在强关联（OR 6.0；95% CI 1.5 - 24.3）。在个体层面，男性与使用呈正相关（OR 1.9；95%，CI （1.0 - 3.4）），并且年龄每增加一岁，使用TDS的机会降低3%（OR 1.0，95% CI 0.9 - 1.0）。没有其他因素与实施相关。“良好”是最常见的总体印象（54.8%），并且大多数人发现使用该系统没有问题（> 85%）。最常见的抱怨是技术问题，其次是没有附加值。
TDS 的成功实施与中心层面硬件设备的到位以及个体层面的男性性别和较年轻年龄密切相关。总体满意度较高。
