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Teledermatology in Scotland - 2014 Update. C. Morton, Stirling, Scotland. Teledermatology in Scotland 2014. Most TD activity: Highland/Western Isles Lanarkshire Forth Valley. Teledermatology in Scotland - 1. NHS Highland
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Teledermatology in Scotland - 2014 Update C. Morton, Stirling, Scotland
Teledermatology in Scotland 2014 Most TD activity: Highland/Western Isles Lanarkshire Forth 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 - 1 NHS 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 Clyde N.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.
