Teledermatologic consultation and reduction in referrals to dermatologists: A cluster randomized controlled trial

Nina Eminović*, Nicolette F. De Keizer, Jeremy C. Wyatt, Gerben Ter Riet, Niels Peek, Henk C. Van Weert, Carla A. Bruijnzeel-Koomen, Patrick J.E. Bindels

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

80 Citations (Scopus)


Objective: To determine whether teledermatologic consultations can reduce referrals to a dermatologist by general practitioners (GPs). Design: Multicenter cluster randomized controlled trial. Setting and Participants: We recruited 85 GPs from 35 general practices in 2 regions in the Netherlands (Almere and Zeist); 5 dermatologists from 2 nonacademic hospitals were also included in the study. Interventions: The GPs randomized to the intervention used a teledermatologic consultation system to confer with a dermatologist, whereas those in the control group referred their patients according to usual practice. All patients, regardless of their condition, were seen in the office by a dermatologist after approximately 1 month. Outcome Measures: The main outcome measure was the proportion of office visits prevented by teledermatologic consultation, as determined by dermatologists at approximately the 1-month office visit. The secondary out come measure was patient satisfaction, measured using the Patient Satisfaction Questionnaire III developed by Ware et al. Results: The 85 study GPs enrolled 631 patients (46 intervention GPs, 327 patients; 39 control GPs, 304 patients). The 5 dermatologists considered a consultation preventable for 39.0% of patients who received teledermatologic consultation and 18.3% of 169 control patients, a difference of 20.7% (95% confidence interval, 8.5%-32.9%). At the 1-month dermatologist visit, 20.0% of patients who received teledermatologic consultation had recovered compared with 4.1% of control patients. No significant differences in patient satisfaction were found between groups. Conclusions: Teledermatologic consultation offers the promise of reducing referrals to a dermatologist by 20.7%. Providing teledermatologic consultation by GPs with more extended knowledge of dermatology may further reduce the need for dermatologist referrals. Trial Registration: Current Controlled Trials No. ISRCTN57478950

Original languageEnglish
Pages (from-to)558-564
Number of pages7
JournalArchives of Dermatology
Issue number5
Publication statusPublished - May 2009

Bibliographical note

This study was supported in part by
Senter Novem (Agency of the Dutch Ministry of Economic Affairs) and ZonMw (Dutch Organization for
Health Research and Development). KSYOS Health Management Research provided the digital cameras and teleconsultation software.


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