title: Does teledermatology reduces secondary care referrals and is it acceptable to patients and doctors?: a service evaluation.
abstract: OBJECTIVE
  Referrals to dermatology for skin lesions is increasing. Teledermatology allows patients to obtain specialist advice remotely. The aim of this study is to assess if teledermatology reduces secondary care dermatology referrals and evaluate its acceptability to patients and clinicians.
  
  
  METHODS
  A 24-month before and after comparative evaluation of a teledermatology service was undertaken involving four non-randomly allocated intervention practices and 18 control practices. Referral data for 12 months before and after the introduction of teledermatology was compared in intervention and control practices. Patient questionnaires explored their satisfaction and structured user dialogues explored the usefulness and benefits to clinicians. Time series analysis, adjusted for age and sex, was undertaken to assess the impact on secondary care referrals.
  
  
  RESULTS
  There were 195 Telederm referrals during the 12-month pilot period. Seborrhoeic keratosis was the commonest diagnosis. No action was required in 86 patients. Urgent referral to secondary care was recommended in 64 patients and routine referral in 19. The difference in referral rate before and after was +2.11 referrals per 1000 practice population in the teledermatology group and +1.39 in the control group. This was statistically significant in the adjusted, but not unadjusted, analysis. There was a 14% response rate for the questionnaire. The service was very popular with patients and clinicians. Clinicians highlighted the significant educational benefit.
  
  
  CONCLUSIONS
  We did not find any evidence that teledermatology reduced secondary care referral rates but in this small pilot, we found that it increased referrals in the short term. It was very popular among patients and clinicians, especially for its educational value.
authors.affiliation: Department of Population Health and Primary Care, University of East Anglia, Norwich, UK.
authors.forename: John A
authors.initials: JA
authors.lastname: Ford
authors.affiliation: Public Health Directorate, Norfolk County Council, Norwich, UK.
authors.forename: Augustine
authors.initials: A
authors.lastname: Pereira
mesh_terms: D001291:Attitude of Health Personnel; D003880:Dermatology; D004739:England; D006302:Health Services Research; D006801:Humans; D010342:Patient Acceptance of Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012871:Skin Diseases / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D017216:Telemedicine
keywords: evaluation; health services research; public health