General Practitioners' Perspectives About Remote Dermatology Care During the COVID-19 Pandemic in the Netherlands: Questionnaire-Based Study

Abstract

Background: The COVID-19 pandemic affected the delivery of primary care and stimulated the use of digital health solutions such as remote digital dermatology care. In the Netherlands, remote store-and-forward dermatology care was already integrated into Dutch general practice before the COVID-19 pandemic. However, it is unclear how general practitioners (GPs) experienced this existing digital dermatology care during the pandemic period.

Objective: We investigated GPs' perspectives about facilitators and barriers related to store-and-forward digital dermatology care during the COVID-19 pandemic in the Netherlands, using a sociotechnical approach.

Methods: In December 2021, a web-based questionnaire was distributed via email to approximately 3257 GPs who could perform a digital dermatology consultation and who had started a digital consultation (not necessarily dermatology) in the previous 2 years. The questionnaire consisted of general background questions, questions from a previously validated telemedicine service user satisfaction questionnaire, and newly added questions related to the pandemic and use of the digital dermatology service in general practice. The open-ended and free-text responses were analyzed for facilitators and barriers using content analysis, guided by an 8-dimensional sociotechnical model.

Results: In total, 71 GPs completed the entire questionnaire, and 66 (93%) questionnaires were included in the data analysis. During the questionnaire distribution period, another national lockdown, social distancing, and stay-at-home mandates were announced; thus, GPs may have had increased workload and limited time to complete the questionnaire. Of the 66 responding GPs, 36 (55%) were female, 25 (38%) were aged 35-44 years, 33 (50%) were weekly platform users, 34 (52%) were working with the telemedicine organization for >5 years, 42 (64%) reported that they used the store-and-forward platform as often during as before the pandemic, 61 (92%) would use the platform again, 53 (80%) would recommend the platform to a colleague, and 10 (15%) used digital dermatology home consultation. Although GPs were generally satisfied with the digital dermatology service, platform, and telemedicine organization, they also experienced crucial barriers to the use of the service during the pandemic. These barriers were GPs' and patients' limited digital photography skills, costs and the lack of appropriate equipment, human-computer interface and interoperability issues on the telemedicine platform, and different use procedures of the digital dermatology service.

Conclusions: Although remote dermatology care was already integrated into Dutch GP practice before the pandemic, which may have facilitated the positive responses of GPs about the use of the service, barriers impeded the full potential of its use during the pandemic. Training is needed to improve the use of equipment and quality of (dermoscopy) images taken by GPs and to inform GPs in which circumstances they can or cannot use digital dermatology. Furthermore, the dermatology platform should be improved to also guide patients in taking photographs with sufficient quality.

Keywords: COVID-19; GP; dermatology; dermoscopy; family physician; general practice; general practitioner; mobile phone; perspective; questionnaire; remote care; teledermatology; teledermoscopy; telehealth; telemedicine.

Figure 1

Teledermatology, teledermoscopy, and digital dermatology home consultation process. GP: general practitioner; TD: teledermatologist.

Figure 2

Questionnaire instrument. General background questions: for example age, sex, the frequency of telemedicine platform use, years of experience with telemedicine platform, self-reported computer skills, and technology adoption. COVID-19 pandemic questions: the frequency of telemedicine platform use, experiences and lessons learned with teledermatology, teledermoscopy, and digital dermatology home consultation. Dermatology home consultation questions: general practitioners’ (GPs) experiences with digital dermatology home consultation (ie, image quality with patients as photographers and needed improvement, which skin conditions and population are suitable for digital dermatology home consultation, and other patient-GP delivery modalities used). The use of digital dermatology consultation in general practice questions: reasons for (not) performing a digital dermatology consultation, the photographer of the (dermoscopic) photographs, the dermatologist feedback received about the quality of the photographs, suggested improvements to optimize photograph quality, GPs’ confidence in teledermatology and teledermoscopy use, and the extent of image training received. SAF-TSUQ: Store-and-Forward Telemedicine Service User-satisfaction Questionnaire.

Figure 3

Store-and-Forward Telemedicine Service User-satisfaction Questionnaire responses to the training, communication, interaction, and use statements. *Additional explanation in the questionnaire—by this question, we meant that a digital consultation can replace a regular consultation.