Digital dermatology in general practice:Past, present and future

General practitioners (GPs) serve as gatekeepers for patients seeking specialized dermatology care and play a crucial role in triaging patients with skin lesions. To support GPs in diagnosing these (suspicious) skin lesions in general practice, they can seek the advice of a teledermatologist through digital dermatology services. This thesis aimed to contribute to understand the value of store-and-forward digital dermatology consultation in Dutch general practice. Furthermore, this thesis aimed to provide insights into experienced facilitators and barriers in the uptake of these digital dermatology services by GPs since its introduction in primary care. First, we investigated the status of two decades of teledermatology worldwide by performing a literature review (Part I). Second, we researched the impact and added value of performing store-and-forward teledermoscopy for GPs in Dutch GP practice (Part II). Finally, we developed and validated a quality feedback tool (SAF-TSUQ) to determine GPs’ perspectives about store-and-forward telemedicine services. We applied and extended this SAF-TSUQ to reveal the factors that facilitate or impede the successful implementation and use of teledermatology, teledermoscopy and dermatology home consultation services in Dutch GP practice (Part III). The evidence from this thesis showed that teledermatology and teledermoscopy are of added value for GPs. These services save cost and time compared to traditional dermatology care and support GPs in their referral decisions for benign and malignant skin lesions. Barriers hinder the full potential of digital dermatology services and addressing these sociotechnical challenges is crucial for enhancing and expanding these services in future general practices

The value of teledermoscopy to the expertise of general practitioners diagnosing skin disorders based on ICD-10 coding

Early recognition of skin cancer is vital to enhance patient outcomes. Teledermoscopy (TDsc), a telemedicine service, supports general practitioners (GPs) in gaining fast access to dermatologists' feedback to detect skin cancer. This study aimed to assess if GPs gain expertise in diagnosing skin disorders after continued use of TDsc, based on diagnosis classification by the International Statistical Classification of Diseases and Related Health Problems (ICD-10). A retrospective study was conducted on TDsc consultations sent by GPs to teledermatologists in the Netherlands (July 2015 - June 2018). GP sensitivity and confirmed cases in diagnosing skin disorders slightly increased over time. However, the total positive predictive value showed a decrease. In three years, 43 melanomas were diagnosed by the TD for which the GP did not provide a (correct) pre-diagnose. Though GPs appear to improve their expertise in skin disorder detection after continued TDsc use, TDsc remains imperative to early melanoma detection