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. 2018 Oct 24;19(1):583.
doi: 10.1186/s13063-018-2955-2.

Improving cooperation between general practitioners and dermatologists via telemedicine: study protocol of the cluster-randomized controlled TeleDerm study

Roland Koch  1 , Andreas Polanc  2 , Hannah Haumann  2 , Gudula Kirtschig  2   3 , Peter Martus  4 , Christian Thies  5 , Leonie Sundmacher  6 , Carmen Gaa  3 , Leonard Witkamp  7   8 ; TeleDerm Study Group; Stefanie Joos  2
Collaborators, Affiliations

Improving cooperation between general practitioners and dermatologists via telemedicine: study protocol of the cluster-randomized controlled TeleDerm study

Roland Koch et al. Trials. .

Abstract

Background: Internationally, 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.

Methods: The 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.

Discussion: Due 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 registration: German Clinical Trials Register, DRKS00012944 . Registered prospectively on 31 August 2017.

Keywords: Consultation; Implementation; Primary care; Referral; Teledermatology; Telemedicine.

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Conflict of interest statement

Ethics approval and consent to participate

The ethics review board of the Eberhard-Karls-University Tübingen gave a positive vote on the study (DNR 395/2017BO1).

Consent for publication

Not applicable.

Competing interests

LW is professor appointed by the Dutch Royal Medical Association at the Department of Medical Informatics at the Academic Medical Centre in Amsterdam; he is also an owner and director of KSYOS, but as such is not involved in this study.

The remaining authors declare that they have no disqualifying factors or conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
SPIRIT 2013 figure with schedule of enrolment, interventions and assessments. GP general practitioner, HzV Hausarztzentrierte Versorgung
Fig. 2
Fig. 2
Project timeline of the 3-year project. GP general practitioner
Fig. 3
Fig. 3
Overview of clusters: different levels or clusters of the project. AOK Allgemeine Ortskrankenkasse, GP general practitioner, HzV Hausarztzentrierte Versorgung
Fig. 4
Fig. 4
Recruitment and flow. Flow diagram (adapted and modified from the CONSORT statement) demonstrating how the two-step recruitment process and patient flow work. AOK Allgemeine Ortskrankenkasse, CONSORT Consolidated Standards of Reporting Trials, GP general practitioner, HzV Hausarztzentrierte Versorgung
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