Dermatology Dialogue Service Led to Patient, Clinician Satisfaction in Reducing Wait Lists

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A newly-designed dermatology dialogue service between primary and secondary care (DDPS) is shown to be satisfactory among patients and physicians, according to new findings, given that its use coincided with dermatology waiting list decreases compared to what was anticipated.¹

These findings resulted from a recent analysis of this dermatology pathway that was put into use by Norfolk and Waveney (N&W) in the UK, with the goal being to develop a clinically sustainable service given longer waitlists in England for dermatology care.

This research was led by Julii Brainard, from University of East Anglia’s Norwich Medical School. Brainard and colleagues noted that the system involved primary care referrers uploading images of their patients’ skin conditions for the purposes of a review by consultant dermatologists.

“Patients see their GPs about a range of skin conditions including rashes and spots that have changed in size and shape,” Brainard said in a statement. “In many cases, GPs need to refer patients to dermatologists - but wait lists to be seen can be long. We wanted to see if uploading photos and patient history details to a specially designed platform, to be assessed by dermatologists remotely, could help reduce patient waiting times.”²

Background and Methods

As mentioned, the dialogue service in dermatology was formed in the eastern region of England with the purpose of facilitating communication between primary and secondary care providers. Primary care referrers would submit images for discussion and review with consultant dermatologists.¹

The research team’s assessment of this dialogue service's performance was based upon specific targets, a primary example of which being a notable reduction in the growth of the secondary care waiting lists in the period between April 2021 - March 2022. The dialogue service's activity was assessed by the team using the number of cases handled, speed of case resolution, and case outcomes.

The investigators looked into levels of satisfaction among physicians as well as patients through the use of structured questionnaires. They would compare actual new referral numbers with figures that were projected and had been derived thanks to historical data.

Another notable element of the research team’s analysis was the waiting list growth in the field of dermatology and its comparison to that of different specialties and commissioning areas. They also assessed waiting times for initial treatment.

Findings

Overall, the investigators had over 3300 participants become involved in their research and more than 90% of the queries were found to have been resolved within a 36-hour span. High satisfaction levels with the program were observed among both medical professionals and patients.

The dermatologists involved pointed to common questions and conditions, which was shown to have led to an educational program for providers of primary care that were given positive feedback. The dialogue service had also been shown to have helped identify key gaps in diagnostic skills and, thus, contributed to an education and training event for primary care staff members.

The investigators noted that the majority of their key performance indicator (KPI) targets were achieved. They added that more than 60% of the resolved cases directed to the DDPS pathway continued to be in primary care, leading to a bypassing of specialist wait lists.

The research team did note a lack of clear association with the DDPS's performance on the "cancer" pathway, either positive or negative. In the service’s operational period, the team found that growth in wait list size had been significantly smaller than the typical increases observed by other English commissioners in the field of dermatology and other services.

“Taken together, these findings suggest that the DDPS resulted in intelligent pathway management that achieved lower service demand and smaller dermatology waiting lists than would otherwise have occurred in the absence of the DDPS,” they wrote.

References

1. ^{J Brainard, A Crawford, B Wright, et al. Retaining dermatology patients in primary care through dialogue with secondary care providers: A service evaluation. Annales de Dermatologie et de Vénéréologie, Volume 151, Issue 2, 2024, 103248, ISSN 0151-9638. https://doi.org/10.1016/j.annder.2024.103248.}
2. ^{The dermatology initiative that could reduce NHS wait lists. EurekAlert! March 21, 2024. https://www.eurekalert.org/news-releases/1038565. Date accessed: March 26, 2024.}