PDF(Pubmed)
Abstract：
BACKGROUND: Skin cancer rates are at all-time highs, but the shortage of dermatologists compels patients to seek medical advice from general practitioners. A new referral pathway called the Suspected Skin Cancer (SSC) service was established to provide general practitioners in Waikato, New Zealand, with rapid diagnosis and treatment advice for lesions suspicious for skin cancer.
OBJECTIVE: The aim of this study was to assess the quantity, quality, and characteristics of referrals to the SSC teledermatology service during its first 6 months.
METHODS: A retrospective chart review of all referrals sent to the SSC teledermatology service during the first 6 months of its operation was conducted. Time to advice, diagnoses, diagnostic discordance, adherence to advice, and time to treatment were recorded. Diagnostic discordance between general practitioners, dermatologists, and pathologists was calculated.
RESULTS: The SSC service received 340 referrals for 402 lesions. Dermatologists diagnosed 256 (63.7%) of these lesions as benign; 56 (13.9%) were histologically confirmed as malignant, including 19 (4.7%) melanomas. The overall discordance between referrer and dermatologist on specific and broad (ie, benign or malignant) diagnoses for 402 lesions was 47% and 26% (κ=0.58, SD 0.07), respectively; 44% and 26% (κ=0.61, SD 0.15) between referrer and pathologist; and 18% and 12% (κ=0.82, SD 0.12) between dermatologist and pathologist. The mean time between referral submission and receiving advice was 1.02 days. The average time to action (eg, excision) was 64.8 days.
CONCLUSIONS: An electronic referral system can be an effective form of teledermatology for providing prompt diagnosis and management advice for benign and malignant skin lesions.
OBJECTIVE: The aim of this study was to assess the quantity, quality, and characteristics of referrals to the SSC teledermatology service during its first 6 months.
METHODS: A retrospective chart review of all referrals sent to the SSC teledermatology service during the first 6 months of its operation was conducted. Time to advice, diagnoses, diagnostic discordance, adherence to advice, and time to treatment were recorded. Diagnostic discordance between general practitioners, dermatologists, and pathologists was calculated.
RESULTS: The SSC service received 340 referrals for 402 lesions. Dermatologists diagnosed 256 (63.7%) of these lesions as benign; 56 (13.9%) were histologically confirmed as malignant, including 19 (4.7%) melanomas. The overall discordance between referrer and dermatologist on specific and broad (ie, benign or malignant) diagnoses for 402 lesions was 47% and 26% (κ=0.58, SD 0.07), respectively; 44% and 26% (κ=0.61, SD 0.15) between referrer and pathologist; and 18% and 12% (κ=0.82, SD 0.12) between dermatologist and pathologist. The mean time between referral submission and receiving advice was 1.02 days. The average time to action (eg, excision) was 64.8 days.
CONCLUSIONS: An electronic referral system can be an effective form of teledermatology for providing prompt diagnosis and management advice for benign and malignant skin lesions.
摘要：
背景：皮肤癌发病率处于历史最高水平，但是皮肤科医生的短缺迫使患者向全科医生寻求医疗建议。建立了一个新的转诊途径，称为疑似皮肤癌（SSC）服务，为怀卡托的全科医生提供服务，新西兰,对可疑皮肤癌的病变提供快速诊断和治疗建议。
目的：本研究的目的是评估数量，质量,以及在头6个月转诊到SSC远程皮肤病服务的特征。
方法：对SSC手术前6个月的所有转诊患者进行回顾性分析。时间的建议，诊断,诊断不一致，坚持建议，并记录治疗时间。全科医生之间的诊断不一致，皮肤科医生,和病理学家计算。
结果：SSC服务部门收到了340个402个病变的转诊。皮肤科医生诊断其中256例（63.7%）为良性；56例（13.9%）经组织学证实为恶性，包括19例（4.7％）黑色素瘤。引荐者和皮肤科医生在具体和广泛上的总体不一致(即，良性或恶性）402个病变的诊断分别为47％和26％（κ=0.58，SD0.07），分别为44％和26％（κ=0.61，SD0.15）；皮肤科医生和病理学家之间分别为18％和12％（κ=0.82，SD0.12）。提交转诊和接受建议之间的平均时间为1.02天。平均行动时间(例如，切除）为64.8天。
结论：电子转诊系统可能是一种有效的远程皮肤病学形式，可以为良性和恶性皮肤病变提供及时的诊断和管理建议。
目的：本研究的目的是评估数量，质量,以及在头6个月转诊到SSC远程皮肤病服务的特征。
方法：对SSC手术前6个月的所有转诊患者进行回顾性分析。时间的建议，诊断,诊断不一致，坚持建议，并记录治疗时间。全科医生之间的诊断不一致，皮肤科医生,和病理学家计算。
结果：SSC服务部门收到了340个402个病变的转诊。皮肤科医生诊断其中256例（63.7%）为良性；56例（13.9%）经组织学证实为恶性，包括19例（4.7％）黑色素瘤。引荐者和皮肤科医生在具体和广泛上的总体不一致(即，良性或恶性）402个病变的诊断分别为47％和26％（κ=0.58，SD0.07），分别为44％和26％（κ=0.61，SD0.15）；皮肤科医生和病理学家之间分别为18％和12％（κ=0.82，SD0.12）。提交转诊和接受建议之间的平均时间为1.02天。平均行动时间(例如，切除）为64.8天。
结论：电子转诊系统可能是一种有效的远程皮肤病学形式，可以为良性和恶性皮肤病变提供及时的诊断和管理建议。
