title: Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.
abstract: BACKGROUND
  Teledermatology, the application of telemedicine in the field of dermatology, has similar accuracy and reliability as physical dermatology. Teledermatology has been widely used in daily practice in the Netherlands since 2005 and is fully reimbursed.
  
  
  OBJECTIVE
  This study prospectively investigated the effect of teledermatology on efficiency, quality and costs of care when integrated in daily practice and applied following patient selection by the general practitioner (GP).
  
  
  METHODS
  Teledermatology consultations between GP and regional dermatologist were performed in daily GP practice in the Netherlands. Efficiency of care was measured by the decrease in the number of physical referrals to the dermatologist. Quality of care was measured by the percentage of teleconsultations for second opinion, physical referrals resulting from these teleconsultations, the response time of the dermatologists and educational effect experienced by the GP. Costs of conventional healthcare without teledermatology were compared with costs with teledermatology.
  
  
  RESULTS
  One thousand, eight hundred and twenty GPs and 166 dermatologists performed teledermatology, and 37,207 teleconsultations performed from March 2007 to September 2010 were included. In the group of patients where the GP used teleconsultation to prevent a referral (n =26,596), 74% of physical referrals were prevented. In the group of patients where the GP used teleconsultation for a second opinion (n =10,611), 16% were physically referred after teleconsultation. The prevented referral rate in the total population was 68%. The mean response time of dermatologists was 4·6 h (median 2·0). GPs indicated that there was a beneficial educational effect in 85% of the teleconsultations. The estimated cost reduction was 18%.
  
  
  CONCLUSIONS
  Teledermatology can lead to efficient care probably at lower cost. We are therefore of the opinion that teledermatology following GP selection should be considered as a possible pathway of referral to secondary care.
authors: Departments of Dermatology Medical Informatics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. j.p.vanderheijden@amc.uva.nl
authors: J P
authors: JP
authors: van der Heijden
authors: N F
authors: NF
authors: de Keizer
authors: J D
authors: JD
authors: Bos
authors: P I
authors: PI
authors: Spuls
authors: L
authors: L
authors: Witkamp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003880:Dermatology / Q000191:economics* / Q000379:methods; D017598:Efficiency, Organizational; D005194:Family Practice / Q000191:economics* / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D018579:Patient Selection; D011364:Professional Practice / Q000191:economics / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care; D019114:Remote Consultation / Q000191:economics*; D012189:Retrospective Studies; D012871:Skin Diseases / Q000191:economics / Q000628:therapy*; D014504:Urban Health; D055815:Young Adult