title: A randomized controlled trial using instant photography to diagnose and manage dermatology referrals.
abstract: BACKGROUND
  Fifteen percent of GP consultations are for dermatological conditions; 4% of these are referred to a dermatologist. There are long waiting lists for dermatology appointments. This study examines the value of instant photography in managing dermatology referrals.
  
  
  OBJECTIVE
  The purpose of our study was to compare outcomes of referral for dermatology appointments between patients whose referral letters do or do not include instant photograph(s).
  
  
  METHODS
  Patients (136), referred to a dermatologist by GPs in two urban health centres, were randomly allocated to study and control groups. Instant photographs, taken by the GP, were included in the referral letters. Control group patients were given out-patient appointments in the usual way. The numbers of study group patients needing an appointment for diagnosis or management and with a changed diagnosis after face-to-face consultation were recorded. Waiting time from referral to appointment or management plan was recorded for both groups.
  
  
  RESULTS
  For 63% of the study group (45/71), a diagnosis and a management plan were made without the patient requiring an appointment. This included 38% (27/71) who, after diagnosis and initial management, needed an appointment and 25% (18/71) who did not. The remainder of the study group (37%; 26/71) required a face-to-face consultation. The mean time for formulation of a management plan for patients without an appointment was 17 days (SD = 11); waiting times for appointments in study and control groups were similar (mean 55 days; SD = 40).
  
  
  CONCLUSIONS
  Instant photography is helpful in managing dermatology referrals and offers the potential to reduce numbers requiring an out-patient appointment by 25%.
authors.affiliation: Department of General Practice, Queen's University, Royal Victoria Hospital, Belfast, UK. drpfl@doctors.org.uk
authors.forename: P
authors.initials: P
authors.lastname: Leggett
authors.forename: A E W
authors.initials: AE
authors.lastname: Gilliland
authors.forename: M E
authors.initials: ME
authors.lastname: Cupples
authors.forename: K
authors.initials: K
authors.lastname: McGlade
authors.forename: R
authors.initials: R
authors.lastname: Corbett
authors.forename: M
authors.initials: M
authors.lastname: Stevenson
authors.forename: D
authors.initials: D
authors.lastname: O'Reilly
authors.forename: K
authors.initials: K
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003880:Dermatology / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D004739:England; D005194:Family Practice; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010781:Photography; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012871:Skin Diseases / Q000175:diagnosis* / Q000628:therapy; D019037:Urban Health Services