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A Cluster Randomized Controlled Trial

Nina Eminovi, PhD; Nicolette F. de Keizer, PhD; Jeremy C. Wyatt, PhD, MD; Gerben ter Riet, PhD; Niels Peek, PhD; Henk C. van Weert, PhD, MD; Carla A. Bruijnzeel-Koomen, PhD, MD; Patrick J. E. Bindels, PhD, MD

Arch Dermatol. 2009;145(5):558-564. doi:10.1001/archdermatol.2009.44

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 outcome 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

Author Affiliations: Departments of Medical Informatics (Drs Eminovi, de Keizer, and Peek) and General Practice (Drs ter Riet, van Weert, and Bindels), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Health Informatics Centre, University of Dundee, Dundee, Scotland (Dr Wyatt); Horten Centre, University of Zurich, Zurich, Switzerland (Dr ter Riet); and Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands (Dr Bruijnzeel-Koomen).

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