Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial.
OBJECTIVE
To determine whether teledermatologic consultations can reduce referrals to a dermatologist by general practitioners (GPs).


METHODS
Multicenter cluster randomized controlled trial.


METHODS
We recruited 85 GPs from 35 general practices in 2 regions in the Netherlands (Almere and Zeist); 5 dermatologists from 2 nonacademic hospitals were also included in the study. Interventions The GPs randomized to the intervention used a teledermatologic consultation system to confer with a dermatologist, whereas those in the control group referred their patients according to usual practice. All patients, regardless of their condition, were seen in the office by a dermatologist after approximately 1 month.


METHODS
The main outcome measure was the proportion of office visits prevented by teledermatologic consultation, as determined by dermatologists at approximately the 1-month office visit. The secondary outcome measure was patient satisfaction, measured using the Patient Satisfaction Questionnaire III developed by Ware et al.


RESULTS
The 85 study GPs enrolled 631 patients (46 intervention GPs, 327 patients; 39 control GPs, 304 patients). The 5 dermatologists considered a consultation preventable for 39.0% of patients who received teledermatologic consultation and 18.3% of 169 control patients, a difference of 20.7% (95% confidence interval, 8.5%-32.9%). At the 1-month dermatologist visit, 20.0% of patients who received teledermatologic consultation had recovered compared with 4.1% of control patients. No significant differences in patient satisfaction were found between groups.


CONCLUSIONS
Teledermatologic consultation offers the promise of reducing referrals to a dermatologist by 20.7%. Providing teledermatologic consultation by GPs with more extended knowledge of dermatology may further reduce the need for dermatologist referrals. Trial Registration Current Controlled Trials No. ISRCTN57478950.
Eminović
Nina
N
Department of Medical Informatics, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, the Netherlands. eminovic@gmail.com
de Keizer
Nicolette F
NF
Wyatt
Jeremy C
JC
ter Riet
Gerben
G
Peek
Niels
N
van Weert
Henk C
HC
Bruijnzeel-Koomen
Carla A
CA
Bindels
Patrick J E
PJ
D000328:Adult; D016000:Cluster Analysis; D003880:Dermatology / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009819:Office Visits / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010045:Outpatients / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000628:therapy*; D011795:Surveys and Questionnaires