Improved patient satisfaction and diagnostic accuracy in skin diseases with a Visual Clinical Decision Support System-A feasibility study with general practitioners.

Patient satisfaction is an important indicator of health care quality, and it remains an important goal for optimal treatment outcomes to reduce the level of misdiagnoses and inappropriate or absent therapeutic actions. Digital support tools for differential diagnosis to assist clinicians in reaching the correct diagnosis may be helpful, but how the use of these affect patients is not clear. The primary objective of this feasibility study was to investigate patient experience and satisfaction in a primary care setting where general practitioners (GPs) used a visual clinical decision support system (CDSS) compared with standard consultations. Secondary objectives were diagnostic accuracy and length of consultation. Thirty-one patients with a dermatologist-confirmed skin diagnosis were allocated to consult GPs that had been randomized to conduct either standard consultations (SDR, n = 21) or CDSS (n = 16) on two separate study days one week apart. All patients were diagnosed independently by multiple GPs (n = 3-8) in both the SDR and CDSS study arms. Using the CDSS, more patients felt involved in the decision making (P = 0.05). In addition, more patients were exposed to images during the consultations (P = 6.8e-27), and 83% of those that were shown images replied they felt better supported in the consultation. The use of CDSS significantly improved the diagnostic accuracy (34%, P = 0.007), and did not increase the duration of the consultation (median 10 minutes in both arms). This study shows for the first time that compared with standard GP consultations, CDSS assist the GP on skin related diagnoses and improve patient satisfaction and diagnostic accuracy without impacting the duration of the consultations. This is likely to increase correct treatment choices, patient adherence, and overall result in better healthcare outcomes.

Nationwide skin cancer screening in Germany: Evaluation of the training program.

BACKGROUND: In July 2008, the German statutory health insurance introduced a nationwide skin cancer screening program. Before the introduction, eligible physicians had to qualify to perform the screening test and counsel their patients on skin cancer screening. To educate physicians, a curriculum and training materials were developed. Since 2015 a revised curriculum and training materials have been used. The purpose of this paper is to provide information about the curriculum and to evaluate the revised training program. METHODS: A total of 573 completed pre- and posttests were analyzed with regard to changes in the identification of skin cancer, diagnostic accuracy, knowledge, and physicians' self-assessed-confidence. For statistical analysis, Mann-Whitney U test, Cohen's d, and chi-square test were used. RESULTS: General practitioners (GPs) diagnosed 7.45 of 12 skin lesions correctly before and 9.26 after the training course (P < 0.001). Compared to GPs, dermatologists' accuracy was higher at pre- and posttest (pre: 10.03, post: 10.21, P = 0.160). The mean of correctly answered questions increased significantly in knowledge on screening and early detection (4.46-5.14, P < 0.001) as well as skin cancer and skin cancer screening (5.51-6.39, P < 0.001). CONCLUSION: Participating physicians got a comprehensive understanding of skin cancer screening and counseling through the training and increased their diagnostic skills. In particular, GPs identified and diagnosed significantly more skin lesions correctly after the training compared to before the training, while dermatologists' diagnostic skills were high at both times, before and after.