Abstract
BackgroundInternationally, teledermatology has proven to be a viable alternative to conventional physical referrals. Travel cost and referral times are reduced while patient safety is preserved. Especially patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care.MethodsThe TeleDerm study will implement and evaluate store-and-forward teledermatology in 50 general practitioner (GP) practices as an alternative to conventional referrals. TeleDerm aims to confirm that the possibility of store-and-forward teledermatology in GP practices is going to lead to a 15% (n = 260) reduction in referrals in the intervention arm. The study uses a cluster-randomized controlled trial design. Randomization is planned for the cluster “county”. The main observational unit is the GP practice. Poisson distribution of referrals is assumed. The evaluation of secondary outcomes like acceptance, enablers and barriers uses a mixed-methods design with questionnaires and interviews.DiscussionDue to the heterogeneity of GP practice organization, patient management software, information technology service providers, GP personal technical affinity and training, we expect several challenges in implementing teledermatology in German GP routine care. Therefore, we plan to recruit 30% more GPs than required by the power calculation. The implementation design and accompanying evaluation is expected to deliver vital insights into the specifics of implementing telemedicine in German routine care.Trial registrationGerman Clinical Trials Register, DRKS00012944. Registered prospectively on 31 August 2017.
Highlights
Teledermatology has proven to be a viable alternative to conventional physical referrals
The main scientific hypothesis is that the possibility of store-and-forward teledermatology in general practitioner (GP) practices is going to reduce GP referrals to dermatologists by at least 15%
We present the study protocol of a cluster-randomized clinical trial aiming at implementing teledermatology into general practice in Germany
Summary
Teledermatology has proven to be a viable alternative to conventional physical referrals. Patients from rural areas benefit from this healthcare innovation. Despite these established facts and positive experiences from EU neighboring countries like the Netherlands or the United Kingdom, Germany has not yet implemented store-and-forward teledermatology in routine care. Teledermatology is the process of diagnosing dermatologic problems at a physical distance and, in the case of store-and-forward technology, at different times [1]. In about 80% of common conditions, the general practitioner (GP) is able to make a diagnosis and initiate treatment based on clinical examination and patient history [7]. Teledermatology is a viable alternative to physical referrals—especially in rural areas
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