Teledermatology in Scotland - 2014 Update

C. Morton,Stirling, Scotland

Teledermatology in Scotland 2014

Most TD activity:Highland/Western IslesLanarkshireForth Valley

Teledermatology in Scotland - 1

NHS Highland• Telereferals several times most days: management advice, teletriage and

“full” teledermatology (approx 25-30 cases/wk), & look after the Falklands mainly by telederm (approx 20 pts / yr)

NHS Lanarkshire• Photo-triage of skin lesions to prioritise +/- onward referral• ~3600 patients pa

NHS Forth Valley• Community-based phototriage – 2 GP surgeries – 1500 pa.• Audit: only 20% patients require clinic visit – reminder: direct surgery,

nurse led clinic, PDT, or onward referral.

Teledermatology in Scotland - 1NHS Fife• Encourage GPs to attach a photograph with referrals. (not for suspicion of cancer)

NHS Borders• Electronic vetting for a couple of years and GPs can attach photographs• GPs can also email for advice – more useful for management advice.

NHS Tayside• 17% of all referrals arrive with image (all GPs given cameras several years ago• Permits triage or management decisions

NHS Grampian• Teledermoscopy clinic between Elgin and Aberdeen – 100 patients pa.

NHS GG and ClydeN.Argyll – GPs have cameras – encouraged to use email with picture.

NHS Lothian, NHS Ayrshire & Arran - Nil

TD in Scotland – why limited?• Different structure to healthcare – Health Boards oversee Primary &

Secondary care – no commissioning process

• Suspicion of management seeing TD as cheap fix to capacity issues, rather than as part of an integrated service

• 2010 SDS position statement on Teledermatology: cautionary

• Absence of initiatives to drive forward TD

• Poor experience of teleconference facilities used in MDTs

• Research – telephone triage by GPs The Lancet, 4 August 2014 doi:10.1016/S0140-6736(14)61058-8

Telephone triage for management of same-day consultation requests in general practice: a cluster-randomised controlled trial and cost-consequence

analysis

• Evaluate two forms of triage (by GPs, or by Nurses supported by decision support software) and compare them with ‘usual care’.

• 42 practices randomly allocated to provide one of these three access options for four weeks, following a period of training and ‘run-in’

• >20,000 patients requesting a ‘same-day’ appointment enrolled. Followed up through questionnaires and notes review over 28 days.

• Patients who receive a telephone call back from a doctor or a nurse are more likely to require further support or advice when compared to patients who see a doctor in person under the usual care arrangement.

• Conclusion: ‘telephone triage’ systems do not reduce overall practice workload. The costs to the NHS over 28 days were almost identical, so there was no added cost-efficiency.

New models of care for return appointments

• (Quality & Efficiency Support Team)

• Clinicians collaborating to use peer review in three specialties (Derm, Ophth, Gastro) and across NHS FV, Tayside, GG & Clyde

• New patient centred follow-up models

• Primary Drivers for this are:• People attend traditional OP clinics as last resort• Clinic resources are fully utilised• More people are assessed at home or in community

Current status: completion of audit and patient Qs.