BT06 (P163) Implementation of a novel direct-to-patient inflammatory teledermatology service

Abstract Teledermatology for inflammatory dermatoses can be employed at several stages of the patient journey. It is most commonly utilized for advice and guidance (AVG) requests from primary care and for referral screening. However, the variable capacity of overstretched general practitioners to submit digital images and complex login requirements for patients have hindered widespread implementation beyond this. We present pilot results of a novel direct-to-patient teledermatology (DTPT) service, which enabled patients to engage with dermatology services directly. The DTPT service was implemented downstream of our existing AVG and referral triage pathways. We designed a standardized questionnaire based on a full dermatological history and paired it with instructions for capturing high-quality digital images at home. Unselected patients awaiting a new adult inflammatory dermatology outpatient appointment were sent an automated text or email link (with no requirement to log in) via a cloud-based system (Isla Health). They completed the questionnaire on a smart device and submitted it along with photographs in an intuitive manner. Submissions were reviewed alongside referral letters within the Isla system by a consultant dermatologist, working remotely. In total, 582 of 1020 (57.1%) invited patients submitted a questionnaire and photographs during the pilot period (May to October 2024). Of these, 128 (22.0%) patients were discharged from the pending list with specific management recommendations for their general practitioner, 18 (3.1%) were added to the waiting list for patch testing, three (0.5%) were given open appointments, two (0.3%) were added to the waiting list for phototherapy and two (0.3%) were referred directly to another specialty. Overall, 429 of 582 (73.7%) were triaged to subsequent face-to-face review. The most common working diagnoses for patients discharged to primary care with advice were cutaneous infection (17.8%) psoriasis (12.4%) eczema (9.0%), hidradenitis suppurativa (6.2%) and alopecia (4.7%). The results of this pilot study demonstrate that over one-quarter of patients with inflammatory dermatoses who engage with DTPT can be managed without the need for a face-to-face appointment. This has helped reduce pending lists and patient waiting times and avoided unnecessary patient travel. This service model allows for flexible working, enabling nonlocal clinicians or those who wish to work outside of regular hours to contribute. There is potential to increase the scope of DTPT to include arranging initial investigations and hybrid management with remote supervision for patients who do require face-to-face review.