BT24 Use of specialist advice and guidance for dermatology services: the importance of high-quality images in reducing double activity

Abstract

Abstract The use of specialist advice and guidance (A&G), where primary care healthcare professionals request diagnostic and management advice from specialists, is advocated as the ‘front door’ to dermatology services, to optimize referral management. This approach provides the opportunity for a two-way interchange between primary and specialist services, and can facilitate triage to appropriate dermatology services in a timely fashion. For A&G to work effectively, the expectation is that images will accompany the A&G interaction. Ideally, dermoscopic images would accompany skin lesion A&G requests. It is important that the images are of a high enough quality to enable the reviewing clinician to provide a diagnosis and management plan so that ‘double activity’, where an A&G request is reviewed and the patient needs to be seen because of poor-quality images, is avoided. We introduced specialist A&G in August 2021 and developed referral forms for skin lesions. Dermatoscopes were provided to practices. The aim of this study was to review the quality of skin lesion A&G requests and, in particular, to identify whether a diagnosis and management plan was possible based on the information and images provided. Consecutive skin lesion A&G requests were reviewed over a 4-week period, and information was collected on the images accompanying the request and whether the reviewing clinician was able to make a diagnosis and management plan. In total, 160 skin lesion A&G requests were reviewed over the 4-week period. A skin lesion referral form accompanied 42% of the requests, and 92% were accompanied by macroscopic images (42% clearly labelled) and 59.5% by dermoscopic images. In 32% of the requests, it was not possible to make a diagnosis and management plan. This study highlights the fact that the quality of images accompanying A&G skin lesion referrals is often not good enough to make a diagnosis and management plan. Many of these patients will therefore need to be seen for a face-to-face appointment, which leads to ‘double activity’. If A&G services are to work effectively, then it is essential that high-quality images, ideally including dermoscopy images for skin lesions, accompany the A&G requests. Systems need to identify appropriate models to support image-taking services. Such models can be developed locally and might include community image-taking hubs based in agreed primary care settings or community diagnostic centres. A suitably trained workforce needs to be developed to take and send the images.