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Objective
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Comment
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Improve patient experience
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This is controversial, and depends on how teledermatology is used, the geography and what is wrong with patient. Saving long journeys is of more value than short journeys, and patients in rural areas will usually benefit most. Those with widespread inflammatory rashes may prefer to come for initial consultation at hospital to discuss management, although this depends on the care available in the community and efficiency of communication between primary and secondary care.
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Help and educate GPs
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The system needs to be streamlined and easy to access to be of practical use to GPs. In some situations, using teledermatology as a supplement for telephone advice may be more help than trying to use it as a substitute for consultation. Rapid teledermatology feedback will provide a valuable source of visual education for GPs, compared to the usual delay associated with the traditional referral route.
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Reduce waiting lists
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If "new" staff run the service, then in the short run it is likely reduce the time to first visit by freeing up clinic slots. If current staff diversify to teledermatology there is no evidence that this affects the waiting list. However, it may alter the experience or wait of individual patients. Teledermatology also generates follow ups if it is used as a substitute for consultation.
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Provide guidance on management whilst on the waiting list
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This can work and may mean that the patient does not need to be seen when their appointment comes, particularly for self-limiting or benign diagnoses. There is very little long term outcome evidence on this use of teledermatology in the UK, particularly if used for chronic skin conditions that need ongoing dermatological advice. When used to replace a face-to-face consultation with a dermatologist, teledermatology is very dependent on the effiiency of ongoing communication with the GP, and standard of continuing dermatological care and education available in the community.
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Triage patients with skin cancer directly onto skin surgery lists
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Teledermatology can be successfully used to triage patients with small well-defined basal cell carcinomas directly onto a surgical list, providing good pre-operative information is sent in the post. This can save elderly patients a hospital visit, although the patient should always be given the option of attending the clinic prioir to surgery to discuss the procedure if desired. Using teledermatology to triage 2-week wait skin cancer referrals (patients with suspected melanoma or squamous cell carcinoma) directly onto skin surgery lists is more controversial, and in the UK these patients are probably best managed by face-to-face referral at present. The use of teledermatology to diagnose or exclude malignant melanoma remains controversial in the UK, and there are important issues related to software, image technology, and legal implications that need to be addressed before it can be routinely recommended for this purpose.
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Triage patients to ensure appropriate priority
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There are several studies showing that an image can alter the priority to a referral, usually by reducing the priority where it is difficult to interpret a letter. This can free up clinic slots for 2-week wait cancer referrals, and can be particularly useful in areas with long waiting times. However, the cost benefit of teledermatology triage needs to be weighed up carefully, and is very dependent on the resources and staff used to take the photographs and review the images. If simply used to alter priority rather than as a substitute for face-to-face consultation, the patient inconvenience of having images taken needs to be considered. This inconvenience may be minimal if images are taken by the GP, but more significant if the patient has to travel to a medical photographer or trained nurse for photography at another site.
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Fulfil political objectives
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Teledermatology can certainly provide patients with care closer to home, and once in place the equipment can be used for a range of activities, providing close integration between primary and secondary care. The recent introduction of a new tariff for non face-to-face consultation by the Department of Health recognises the potential for teledermatology in future UK health care provision.
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