Teledermatology as a care collaborative and triage model for improving specialist access and efficiency of dermatological care in Singapore. (Preprint)

Abstract

In Singapore, National Skin Centre (NSC) is the main dermatology centre in the public healthcare system. However long appointment waiting times have resulted from heavy referral load. Family Physicians (FPs) who have limited dermatology training may face uncertainty in managing skin conditions and have a low threshold to refer cases to a specialist centre.

To develop a teledermatology network within the same healthcare cluster to reduce NSC appointment waiting time and assist FPs in managing dermatology cases

We developed collaborative care model with teledermatology support involving NSC and National Healthcare Group Polyclinics (NHGP). For each polyclinic, designated clinician leads with additional dermatology training (‘Derm Champs’ or DCs) performed screening of referrals and conducted Store-and-Forward teleconsultations, if needed, with NSC dermatologists for management or triaging.

Over 2 years, polyclinic DCs screened 2258 cases, of which 28.6% were managed in primary care, 67.3% were referred to NSC and 4.0% were referred to emergency or other departments. Almost half of 322 tele-consulted cases avoided onward referral. NSC appointment waiting times were reduced within 6 months of service introduction.

Teledermatology used in the context of a collaborative care network can expedite and improve patient care, helping to triage and reduce specialist referrals. Teledermatology is valuable even in a small country like Singapore with a well-developed healthcare system and will probably be increasingly utilised with technological advances, even in the post-COVID 19 pandemic era.