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Online System Could Cut Referrals to Dermatologists

Suspect skin conditions evaluated by e-mail may also keep lid on costs, study suggests

WEDNESDAY, May 20 (HealthDay News) -- Having general practitioners e-mail photos of suspicious moles and other skin conditions to dermatologists could reduce referrals to the skin specialists by more than 20 percent, new research shows.

Using Web-based technologies could be one way of keeping a lid on medical costs, which have been rising as the population in Western countries ages and the demand for referrals to costly specialists increases.

The study appears in the May issue of the Archives of Dermatology.

"Telemedicine using e-mail or Web sites holds promise for enhancing communication, especially in the area of dermatology, which is visual in nature," said Nina Eminovic of the University of Amsterdam.

Eminovic and colleagues conducted a randomized controlled trial of teledermatologic consultations involving 605 patients who saw general practitioners at 35 medical practices in the Netherlands.

Half of the practices were randomly assigned to participate in the Web-based intervention, in which clinicians took four digital images of the skin problem of 312 patients and attached the photos to a form completed on a secure Web site.

A dermatologist reviewed the form and provided feedback within 48 hours about recommended treatment.

Half of the practices continued to refer patients to dermatologists according to their usual practices. One month later, all patients were seen by one of five dermatologists participating in the study.

The dermatologist then rated whether the consultation was preventable, either because the patient had recovered or the general practitioner could have treated the condition without a specialist's assistance.

The dermatologists determined that 39 percent of the in-person consultations were preventable in the teledermatology group compared with 18.3 percent of the control patients, which was a difference of 20.7 percent.

At the one-month visit, 20 percent of patients who received teledermatologic consultations had recovered compared with 4.1 percent of control patients.

Patients from both groups were asked to complete a satisfaction questionnaire following the study. They reported no differences in general satisfaction with the care received.

"Teledermatologic consultation successfully enables general practitioners to treat patients they would otherwise refer to a dermatologist," the authors conclude. "Further research conducted with more specific patient groups as well as about patient satisfaction should be encouraged."

More information

The American Academy of Dermatology has more on skin conditions and when to see a dermatologist.

-- Jennifer Thomas

SOURCE: Archives of Dermatology, news release, May 18, 2009

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