Teledermatologic consultation and reduction in referrals to dermatologists: a cluster randomized controlled trial

Arch Dermatol. 2009 May;145(5):558-64. doi: 10.1001/archdermatol.2009.44.


Objective: To determine whether teledermatologic consultations can reduce referrals to a dermatologist by general practitioners (GPs).

Design: Multicenter cluster randomized controlled trial.

Setting and participants: We recruited 85 GPs from 35 general practices in 2 regions in the Netherlands (Almere and Zeist); 5 dermatologists from 2 nonacademic hospitals were also included in the study. Interventions The GPs randomized to the intervention used a teledermatologic consultation system to confer with a dermatologist, whereas those in the control group referred their patients according to usual practice. All patients, regardless of their condition, were seen in the office by a dermatologist after approximately 1 month.

Outcome measures: The main outcome measure was the proportion of office visits prevented by teledermatologic consultation, as determined by dermatologists at approximately the 1-month office visit. The secondary outcome measure was patient satisfaction, measured using the Patient Satisfaction Questionnaire III developed by Ware et al.

Results: The 85 study GPs enrolled 631 patients (46 intervention GPs, 327 patients; 39 control GPs, 304 patients). The 5 dermatologists considered a consultation preventable for 39.0% of patients who received teledermatologic consultation and 18.3% of 169 control patients, a difference of 20.7% (95% confidence interval, 8.5%-32.9%). At the 1-month dermatologist visit, 20.0% of patients who received teledermatologic consultation had recovered compared with 4.1% of control patients. No significant differences in patient satisfaction were found between groups.

Conclusions: Teledermatologic consultation offers the promise of reducing referrals to a dermatologist by 20.7%. Providing teledermatologic consultation by GPs with more extended knowledge of dermatology may further reduce the need for dermatologist referrals. Trial Registration Current Controlled Trials No. ISRCTN57478950.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cluster Analysis*
  • Dermatology / methods*
  • Dermatology / statistics & numerical data
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Netherlands
  • Office Visits / statistics & numerical data
  • Outcome Assessment, Health Care
  • Outpatients / statistics & numerical data*
  • Patient Satisfaction / statistics & numerical data
  • Referral and Consultation / statistics & numerical data*
  • Remote Consultation / statistics & numerical data*
  • Retrospective Studies
  • Skin Diseases / therapy*
  • Surveys and Questionnaires

Associated data

  • ISRCTN/ISRCTN57478950