Community photo-triage for skin cancer referrals: an aid to service delivery

C Morton, F Downie, S Auld, B Smith, Marjon Pol van der, P Baughan, J Wells, R Wootton

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

BACKGROUND:
We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.
AIMS:
To compare the outcomes and costs of conventional and photo-triage referral pathways.
METHODS:
This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.
RESULTS:
Photo-triage permitted 91% of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63% (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45% of patients to attend a nurse-delivered clinic, 22% to attend directly for surgery, 2% to attend a community general practice clinic and 2% to be referred on electronically to another specialty. This reduced by 72% the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.
CONCLUSIONS:
Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.
© The Author(s). CED © 2010 British Association of Dermatologists.
Original languageEnglish
Pages (from-to)248-254
Number of pages7
JournalClinical and Experimental Dermatology
Volume36
Issue number3
Early online date10 Nov 2010
DOIs
Publication statusPublished - Apr 2011

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Triage
Skin Neoplasms
Referral and Consultation
Costs and Cost Analysis
Consultants
Community Health Centers
Secondary Care
Photography
General Practice
Health Services
Observational Studies
Primary Health Care
Appointments and Schedules
Nurses

Cite this

Community photo-triage for skin cancer referrals : an aid to service delivery. / Morton, C; Downie, F; Auld, S; Smith, B; Pol van der, Marjon; Baughan, P; Wells, J; Wootton, R.

In: Clinical and Experimental Dermatology, Vol. 36, No. 3, 04.2011, p. 248-254.

Research output: Contribution to journalArticle

Morton, C ; Downie, F ; Auld, S ; Smith, B ; Pol van der, Marjon ; Baughan, P ; Wells, J ; Wootton, R. / Community photo-triage for skin cancer referrals : an aid to service delivery. In: Clinical and Experimental Dermatology. 2011 ; Vol. 36, No. 3. pp. 248-254.
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abstract = "BACKGROUND:We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.AIMS:To compare the outcomes and costs of conventional and photo-triage referral pathways.METHODS:This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.RESULTS:Photo-triage permitted 91{\%} of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63{\%} (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45{\%} of patients to attend a nurse-delivered clinic, 22{\%} to attend directly for surgery, 2{\%} to attend a community general practice clinic and 2{\%} to be referred on electronically to another specialty. This reduced by 72{\%} the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.CONCLUSIONS:Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.{\circledC} The Author(s). CED {\circledC} 2010 British Association of Dermatologists.",
author = "C Morton and F Downie and S Auld and B Smith and {Pol van der}, Marjon and P Baughan and J Wells and R Wootton",
note = "Acknowledgements We thank R. Milligan MBE and Dr G. Gupta for early advice on setting up our pilot. We also thank J. Hunter, medical photographer, for his support in delivering the service, and K. Bonnar and L. Baff for organizational support in the running of the triage service. Initial funding was supplied by the Scottish Centre for Telehealth. The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorates.",
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T1 - Community photo-triage for skin cancer referrals

T2 - an aid to service delivery

AU - Morton, C

AU - Downie, F

AU - Auld, S

AU - Smith, B

AU - Pol van der, Marjon

AU - Baughan, P

AU - Wells, J

AU - Wootton, R

N1 - Acknowledgements We thank R. Milligan MBE and Dr G. Gupta for early advice on setting up our pilot. We also thank J. Hunter, medical photographer, for his support in delivering the service, and K. Bonnar and L. Baff for organizational support in the running of the triage service. Initial funding was supplied by the Scottish Centre for Telehealth. The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorates.

PY - 2011/4

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N2 - BACKGROUND:We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.AIMS:To compare the outcomes and costs of conventional and photo-triage referral pathways.METHODS:This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.RESULTS:Photo-triage permitted 91% of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63% (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45% of patients to attend a nurse-delivered clinic, 22% to attend directly for surgery, 2% to attend a community general practice clinic and 2% to be referred on electronically to another specialty. This reduced by 72% the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.CONCLUSIONS:Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.© The Author(s). CED © 2010 British Association of Dermatologists.

AB - BACKGROUND:We wished to investigate the potential for extending the capacity of the specialist service by using community-based photo-triage for suspected skin cancers.AIMS:To compare the outcomes and costs of conventional and photo-triage referral pathways.METHODS:This was an observational study of conventional and photo-triage referrals. Patients referred for initial photo-triage were invited to visit a medical photographer located in community health centres, who would take high-quality close-up and dermatoscopic images of the patients' lesions. A dermatologist then reviewed the images, and triaged patients to specific treatment clinics. All patients referred by conventional letter were offered initial appointments at the consultant-delivered skin cancer clinic. The difference in costs was assessed by modelling health service use under both pathways.RESULTS:Photo-triage permitted 91% of patients (263/289) to achieve definitive care at first visit to the specialist team, compared with only 63% (117/186) via the conventional referral pathway. The mean waiting time to definitive treatment for patients with skin cancer was slightly reduced with photo-triage. Photo-triage permitted direct booking for 45% of patients to attend a nurse-delivered clinic, 22% to attend directly for surgery, 2% to attend a community general practice clinic and 2% to be referred on electronically to another specialty. This reduced by 72% the number of patients requiring attendance to the consultant clinic, freeing up capacity. Despite the cost of providing medical photography, there was a small cost saving of around £ 1.70 per patient using photo-triage.CONCLUSIONS:Community photo-triage improved referral management of patients with suspected skin cancer, improving the delivery of definitive care at first visit and achieved an increased service capacity. Cost comparison found that the photo-triage model described was marginally cheaper than conventional care, and reduced hospital visits. An integrated primary-secondary care referral pathway that includes photo-triage facilitates a more efficient specialist service while ensuring that all suspicious lesions are viewed by an experienced dermatologist.© The Author(s). CED © 2010 British Association of Dermatologists.

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DO - 10.1111/j.1365-2230.2010.03960.x

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JO - Clinical and Experimental Dermatology

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