title: An assessment of the cost-effectiveness, safety of referral and patient satisfaction of a general practice teledermatology service.
abstract: BACKGROUND
  In the cost-constrained NHS and in the quest for rapid diagnosis, teledermatology is a tool that can be used within general practice to aid in the diagnosis of benign-looking skin lesions and reduce referrals to secondary care. The setting for the study was a single general practice of 6500 patients in suburban Greater London. The aim of the study was to determine: (1) whether teledermatology in a single general practice is cost-effective, (2) whether the correct types of cases are being referred, and (3) if patients are satisfied with the service.
  
  
  METHODS
  Teledermatology was provided by a private provider. A trained member of staff took photographs in the practice. A consultant dermatologist carried out reporting. This is a retrospective analysis of case records over three years. The cases were adult patients (aged 18+) using teledermatology for the diagnosis and management of skin lesions thought to be benign by the general practitioner. Cost-effectiveness was calculated by considering savings made through reduced referral to secondary care, taking into account the cost of the service. To evaluate whether the correct cases were referred we reviewed whether the assessing dermatologist identified any previously undiagnosed skin cancer. Patient satisfaction assessment was performed using a standard questionnaire.
  
  
  RESULTS
  Two hundred and forty-eight patients had teledermatology. These were patients who would have been referred to secondary care for a routine appointment. Of these, 102 were subsequently referred to secondary care and 146 were managed within the practice. Teledermatology saved £12 460 over the 3-year period. Patients were followed for up to 51 months and no lesions were found to be malignant. Ninety-seven percent of patients rated themselves as satisfied/very satisfied and 93% found the procedure comfortable/very comfortable. The median wait for the photos to be taken was 7 days, and 1-2 weeks for results.
  
  
  CONCLUSIONS
  Teledermatology has been shown to be cost-effective, with referrals identified correctly when employed in this general practice setting. Satisfaction with the service was high.
authors.affiliation: GP Principal, Hillingdon CCG, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Livingstone
authors.affiliation: Medical Student, UCL, London, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Solomon
keywords: dermatology; general practice; primary health care; telemedicine