P29 Selfies: not ideal!

Abstract

Abstract We sought to determine whether the quality of photographic referrals from primary care had been impacted by the COVID-19 pandemic. A total of 2411 referrals made in 2020, 2021 and 2022 were retrospectively reviewed. From this, data were collected on urgent suspected cancer (USC) referrals (n = 1174) made between 1 January and 31 March. For each referral, the photographs included were reviewed. Eighty-four per cent of the 271 USC referrals made in 2020 included photos, 90.3% of the 413 referrals in 2021 and 91.2% of the 490 referrals in 2022. We devised criteria to determine quantitatively the quality of photographs based on the presence of a locator image, a close-up image, a ruler, a dermatoscopic image and whether the photos were in focus. Each feature scored 1, generating a quality score of 0–5. The mean quality scores in 2020, 2021 and 2022 were 2.16, 2.13 and 2.30, respectively. A Kruskal–Wallis test was performed to determine whether there was statistical significance to the differences seen between the sample groups. The alternative hypothesis was that the distribution of the quality scores across the sample groups was unequal. An overall P-value of 0.075 was generated, which was below the threshold of 0.1; therefore, the alternative hypothesis was accepted. On paired comparison between the sample groups, there was a statistically significant increase from 2021 to 2022, with an adjusted P-value of 0.069. We also subjectively judged whether the photos from each referral had made a positive impact on the final diagnosis. Seventy-five per cent (n = 170) of referrals in 2020, 251 (67.3%) in 2021 and 356 (79.6%) in 2022 included photos that had a positive impact on the final diagnosis. To conclude, our results showed that there was a significant decrease in the quality of photographs included in USC referrals in 2021 when compared with the sample groups of 2020 and 2022, suggesting that the COVID-19 pandemic had a negative impact on the triage of USC referrals from primary care. This could be explained by the reduction in face-to-face consultations and an increase in the number of patient-provided images. The results highlight that a significant proportion of images sent by general practitioners and patients are of insufficient quality for effective review and diagnosis. Possible solutions proposed include further provision of medical photography services and education. This work will be used as a baseline for the introduction of a teledermatology service.