Primary care Electronic Referrals: Focus on Efficient Consultation using Telemedicine in Dermatology.

PERFECTD is a multi-centre randomised controlled trial where the general practitioners are randomised in two groups.

1. The intervention group of GPs uses a teledermatology online system to refer patients to the outpatient dermatologists. The dermatologist provides an online advice within 2 days how to treat the patient or perform additional investigations. The dermatologist can also propose an urgent live visit if necessary.

2. The control group of physicians refers dermatological patients without teledermatology, as usual.

All patients, from both intervention and control group are seen live by a dermatologist. A proportion of intervention group patients will be recovered/recovering due to the teledermatology treatment suggestions which could mean that face-to-face consultation with a dermatologist might have been prevented (primary outcome measure: proportion of preventable referrals).

Other outcome measures are: diagnostic accuracy, learning effect GP’s, delay in treatment, patient satisfaction.

In January 2004 the first health care region started with PerfectD with 56 GPs in 14 practices. A second region was included in December 2004 with 51 GPs.

3. The inclusion of the patients will be completed at the end of 2005.
In 2004 PERFECTD has been extended by a subproject PERFECT D Costs.

This project is set up to investigate whether a decrease in outpatient referrals due to teledermatology will also result in cost reduction for the society.

The study is granted by ZonMw as part of Health care Efficiency Research Programme (DoelmatigheidsOnderzoek).

Teledermatology will prevent referals to the dermatologist:

The proportion of preventable referrals will be significantly higher in the intervention group of patients (GP uses teledermatology) than in the control group.

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Semi-structured electronic referral form supported by digital images of skin condition with the possibility to ask a dermatologist for an advice on treatment/investigations prior to the consultation.