title: Teledermatology: quality assessment by user satisfaction and clinical efficiency.
abstract: BACKGROUND
  The Israel Defense Forces implemented a pilot teledermatology service in primary clinics.
  
  
  OBJECTIVE
  To assess user satisfaction and clinical short-term effectiveness of a computerized store and forward teledermatology service in urban and rural units.
  
  
  METHODS
  A multi-center prospective uncontrolled cohort pilot trial was conducted for a period of 6 months. Primary care physicians referred patients to a board-certified dermatologist using text email accompanied by digital photographs. Diagnosis, therapy and management were sent back to the referring PCP. Patients were asked to evaluate the level of the CSAFTD service, effect of the service on accessibility to dermatologists, respect for privacy, availability of drugs, health improvement and overall satisfaction. PCPs assessed the quality of the teledermatology consultations they received, the contribution to their knowledge, and their overall satisfaction.
  
  
  RESULTS
  Tele-diagnosis alone was possible for 95% (n=413) of 435 CSAFTD referrals; 22% (n=95) of referrals also required face-to-face consultation, Satisfaction with CSAFTD was high among patients in both rural and urban clinics, with significantly higher scores in rural units. Rural patients rated the level of service, accessibility and overall satisfaction higher than did urban patients. PCPs were satisfied with the quality of the service and its contribution to their knowledge. Rural physicians rated level of service and overall satisfaction higher than did urban physicians. Tele-referrals were completed more efficiently than referral for face-to-face appointments.
  
  
  CONCLUSIONS
  CSAFTD provided efficient, high quality medical service to rural and urban military clinics in the IDF.
authors.affiliation: Israel Defense Forces Medical Corps.
authors.forename: Itay
authors.initials: I
authors.lastname: Klaz
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wohl
authors.forename: Nir
authors.initials: N
authors.lastname: Nathansohn
authors.forename: Nir
authors.initials: N
authors.lastname: Yerushalmi
authors.forename: Sharon
authors.initials: S
authors.lastname: Sharvit
authors.forename: Ilan
authors.initials: I
authors.lastname: Kochba
authors.forename: Sarah
authors.initials: S
authors.lastname: Brenner
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003201:Computers; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008887:Military Medicine; D017060:Patient Satisfaction; D010821:Physicians, Family / Q000523:psychology; D011787:Quality of Health Care; D012424:Rural Population; D012871:Skin Diseases / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D017216:Telemedicine; D014505:Urban Population