Community photo-triage for skin cancer referrals: an aid to service delivery.
BACKGROUND
We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.


OBJECTIVE
To compare the outcomes and costs of conventional and photo-triage referral pathways.


METHODS
This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.


RESULTS
Photo-triage permitted 91% of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63% (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45% of patients to attend a nurse-delivered clinic, 22% to attend directly for surgery, 2% to attend a community general practice clinic and 2% to be referred on electronically to another specialty. This reduced by 72% the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.


CONCLUSIONS
Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.
NHS Forth Valley Department of Dermatology, Stirling Royal Infirmary, Stirling, UK. colin.morton@nhs.net
C A
CA
Morton
F
F
Downie
S
S
Auld
B
B
Smith
M
M
van der Pol
P
P
Baughan
J
J
Wells
R
R
Wootton
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D046169:Dermoscopy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010781:Photography / Q000191:economics; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D019114:Remote Consultation / Q000191:economics / Q000379:methods; D012606:Scotland; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics; D014218:Triage / Q000191:economics / Q000379:methods*; D055815:Young Adult