BT14 An analysis of a phototriage service for an island community

Abstract An efficient teledermatology service for lesions is essential in a health board providing care to an island community. A photography service coordinated by a mainland referral management team and undertaken by allied healthcare professionals under medical photographer guidance was established on the Isle of Arran (population 4629) in February 2023. Photography training was delivered face-to-face with practical experience, supplemented by a training video and standard operating procedure. Image quality was monitored and improved with ongoing feedback of images. The designated community imaging service offers multifaceted benefits: capturing high-quality photographs, reducing time until specialist input and potentially reducing travel for selected patients. This adjunct service improves access to dermatology care in isolated areas but relies on physician confidence and high-quality images to enable diagnostic certainty. In a 12-month period 98 referrals were vetted to a new lesion appointment. Of these, 31 cases were directed to the community photography service. Overall, 19% (n = 6) were discharged directly or redirected to another speciality and did not require appointments. Of the 14 patients seen so far, 29% (n = 4) were discharged with reassurance of benign diagnoses, while 71% (n = 10) required excision or diagnostic biopsy. Only one of these patients was allocated to a designated ‘one-stop’ clinic enabling a same-day procedure. The remaining 64% (n = 9) were added to the waiting list for a separate surgical appointment. The robust rural general practitioner service often attached good-quality images with referrals, enabling efficient triage. By introducing this service, we have managed to avoid six appointments and the associated travel. In addition, we have recommended prioritizing island referrals for ‘one-stop’ clinics to further limit unnecessary travel, which had improved on our 2nd-year analysis. Second appointments pose challenges for an island community where ferry delays can lead to further diagnostic delay, in addition to wider financial and environmental impact of avoidable appointments. Despite challenges, teledermatology has the potential to improve access to dermatological care in this island community, reduce unnecessary travel and contribute to sustainability through streamlined appointments. The support of allied healthcare professionals in rural settings can make these services possible. Additionally, a well-functioning teledermatology system offers educational opportunities for primary care physicians, which is particularly relevant in an island setting.