BT07 Two-week-wait teledermatology referrals: impact of referrer role and consultation modality

Abstract

In our trust, use of teledermatology for assessing 2-week wait (2WW) referrals has increased. Concerns have been raised about referral quality from nonmedical practitioners and remote primary care consultations. Evidence to support these concerns is limited. The aim of this study was to determine whether nondoctor reviews and remote primary care consultations are associated with higher rates of benign teledermatology outcomes suitable for discharge. This retrospective study included patients referred under the 2WW skin cancer pathway and triaged via a teledermatology service over a 6-week period. Referral data included referrer role (doctor vs. nondoctor), consultation type (face to face, e-consultation, telephone) and teledermatology outcome (discharge, routine follow-up, referral for diagnostic or definitive surgical management, or conversion to face-to-face 2WW). Lesion images were taken by medical photographers and reviewed in consultant-led teledermatology clinics. Proportions were compared using χ2-tests. In total, 200 patients were included; 78% of referrals followed face-to-face consultations, 8.5% e-consultations, 9% telephone consultations and 4.5% unclear consultation types. Overall, 86.5% (n = 173) of referrals were from doctors and 13.5% (n = 27) from nondoctors. Teledermatology outcomes were discharge in 49%, referral for diagnostic or definitive surgical management in 40%, routine follow-up in 7% and conversion to face-to-face 2WW in 5%. Discharge rates did not differ significantly between doctor and nondoctor referrers (48.6% vs. 48%, χ2 = 0.000, P > 0.99). There was no significant difference in discharge rates between face-to-face and non-face-to-face consultations (48.1% vs. 50%, χ2 = 0.003, P = 0.96). In this 2WW teledermatology service, nondoctor and remote primary care consultations did not produce higher discharge rates than doctor-led, face-to-face reviews. These findings do not support blanket rejection of 2WW teledermatology referrals from nondoctors or remote consultations. Instead, they support focusing quality initiatives on referrer education, image quality and clinical information across professional groups.