TY  - JOUR
U1  - Zeitschriftenartikel, wissenschaftlich - begutachtet (reviewed)
A1  - Koch, Roland
A1  - Rösel, Inka
A1  - Polanc, Andreas
A1  - Thies, Christian
A1  - Sundmacher, Leonie
A1  - Eigentler, Thomas
A1  - Martus, Peter
A1  - Joos, Stefanie
T1  - TELEDerm: Implementing store-andforward teledermatology consultations in general practice: Results of a cluster randomized trial
JF  - Journal of telemedicine and telecare
N2  - Background
Although teledermatology has been proven internationally to be an effective and safe addition to the care of patients in primary care, there are few pilot projects implementing teledermatology in routine outpatient care in Germany. The aim of this cluster randomized controlled trial was to evaluate whether referrals to dermatologists are reduced by implementing a store-and-forward teleconsultation system in general practitioner practices.

Methods
Eight counties were cluster randomized to the intervention and control conditions. During the 1-year intervention period between July 2018 and June 2019, 46 general practitioner practices in the 4 intervention counties implemented a store-and-forward teledermatology system with Patient Data Management System interoperability. It allowed practice teams to initiate teleconsultations for patients with dermatologic complaints. In the four control counties, treatment as usual was performed. As primary outcome, number of referrals was calculated from routine health care data. Poisson regression was used to compare referral rates between the intervention practices and 342 control practices.

Results
The primary analysis revealed no significant difference in referral rates (relative risk  = 1.02; 95% confidence interval = 0.911–1.141; p = .74). Secondary analyses accounting for sociodemographic and practice characteristics but omitting county pairing resulted in significant differences of referral rates between intervention practices and control practices. Matched county pair, general practitioner age, patient age, and patient sex distribution in the practices were significantly related to referral rates.

Conclusions
While a store-and-forward teleconsultation system was successfully implemented in the German primary health care setting, the intervention's effect was superimposed by regional factors. Such regional factors should be considered in future teledermatology research.
KW  - telemedicine
KW  - general practice
KW  - teleconsultations
KW  - teledermatology
KW  - regional
KW  - family medicine
KW  - cluster randomized controlled trial
KW  - telehealth
Y1  - 2022
SN  - 1357-633X
SS  - 1357-633X
U6  - https://doi.org/10.1177/1357633X221089133
DO  - https://doi.org/10.1177/1357633X221089133
SP  - 1
EP  - 14
S1  - 14
PB  - Sage Publishing
CY  - London
ER  -