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Adequate central resources:
Time for teledermatology service allocated in job plan of dermatologist, allowing rapid feedback of advice to referring practitioner.
Good links with local GP users prior to setting up the teledermatology service, to encourage regular and appropriate use of the service.
Close ongoing communication with local GP users for regular audit of service and feedback of appropriate / inappropriate referrals
Streamlined electronic or paper booking service for patients requiring face-to-face dermatological consultation in the hospital after teledermatology
Integration of teledermatology referral into hospital notes if face-to-face hospital consultation required
Close links with hospital medical photography department
Enthusiastic and forward-thinking information technology department
Affordable software system with good IT support
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Inadequate central resources:
Informal teleservice with no protected time allocated to allow quick responses to teledermatology referrals
Inadequate links established with GP users prior to setting up the service, so inappropriate or underuse of service
Lack of close communication with GP users to provide verbal advice to support teledermatology service if required
Lengthy waits for patients requiring face-to-face consultation if returned to GP to make standard referral
Teledermatology referral not easily accessible in the outpatient clinic if face-to-face consultation required.
Poor links with hospital medical photography and information technology departments
Expensive software system with unreliable IT backup
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Staff resources to take photographic images. Ideally the images are taken in the GP practice or as close to the practice as possible. Images can be taken by either:
1. a trained nurse (ideally a dermatology nurse with knowledge the distribution of skin diseases)
2. the GP if consultation time allows.
3. a medical photographer (less likely to be available on site)
Access to initial training to take high quality dermatological images (this may be via the local hospital medical photography department)
Integration of the teledermatology system with the GP practice IT systems and patient record
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Inadequately trained staff to take high quality dermatological images of relevant body sites
Insufficient time allocation in primary care to allow for photographic imaging on day of GP appointment, so patient required to make a separate visit for photographs
No facilities for photographic imaging at GP practice, so patient required to make separate visit to another site for imaging (eg local community hospital or medical photography department)
Insufficient history recorded by GP or nurse to allow an accurate diagnosis to be made based on photographic images
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