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Background In recent years, the introduction of the E‑Health Act and the relaxation of the ban on remote treatment has improved the framework for telemedicine in Germany. Objectives The aim of this article is to present an overview of the evidence of different areas of application for teledermatology. Materials and methods A narrative review of national and international studies and projects on the use of teledermatology for diagnosis, monitoring of diseases, triage between primary care physicians (PCPs) and dermatologists, and its use in facilities with reduced organizational and/or geographical access to specialist care was conducted. Results Diagnostic applications allow teledermatological assessment in a large proportion of cases, with high concordance of diagnosis and patient satisfaction. For the monitoring of patients, the majority of studies demonstrated no difference in effectiveness between on-site and remote consultation, while patients are spared travel distance and waiting time. For programs enabling triage most of the patients with dermatologic conditions were able to remain with the PCP, while acute patients requiring direct referral to a dermatologist were identified. In special facilities, such as prisons, dermatological teleconsultations are successfully utilized. Conclusion An adequate framework and promising evidence for the use of teledermatology exist. The areas of application are described in detail within the German S2k guideline for teledermatology. However, there is a potential risk for decreased access to telemedicine services for certain population groups.

Background and objectives: Documenting patient data in psoriasis clinical practice can improve care, but standardized and transparent documentation is rare. The current project aimed to develop a data set for the documentation of psoriasis in daily practice. Material and methods: In four online Delphi rounds and one in-person meeting, 27 psoriasis experts allocated variables to a standard, an optimal and an optional data set. Most of the questions were standardized. Open questions were included to allow for the provision of reasons and to enlarge the data sets. Furthermore, in the in-person meeting we considered a) patients' attitudes and b) dermatologists' information on the current usage and acceptability in Germany. Results: The consensus approach resulted in a data set with 69 variables. The standard data set includes 20, the optimal data set 31 and the optional data set 18 variables. In summary, the data set can mainly be grouped into master data, general status and medical history data, medical history of psoriasis, status of psoriasis, diagnostics and comorbidity, therapies and patient-reported outcomes. Conclusions: The consensus recommendation of a standard, an optimal and an optional data set for routine care of psoriasis intends to be a decision-making aid and an orientation for both daily practice and further development of documentation systems.

Background Health fluctuations even within a single day are typical in multiple sclerosis (MS), but are not captured by widely used questionnaires like the EQ-5D-5L. This exploratory study aimed to develop an ambulatory assessment (AA) version of the EQ-5D-5L (EQ-5D-AA) where patients rate their health on mobile phones multiple times per day over several days, and to assess its feasibility and face validity. Methods An initial EQ-5D-AA version was based on two patient focus groups. It was then tested and continuously developed in an iterative process: patients completed it over several days, followed by debriefing interviews. Findings were used to refine the EQ-5D-AA, with the resulting version being tested by the subsequent wave of patients until participants declared no need for changes anymore. Before and after the AA period, participants completed the standard paper-based EQ-5D-5L asking about ‘today’. Results Focus group participants reported that their impairments often fluctuated between and within days. They regarded an AA with three assessments per day over seven days most appropriate; assessment should be retrospective to the previous assessment, but not all items should be assessed at each time point. Four waves of AA testing were conducted. Thirteen out of the 17 participants preferred the AA over standard assessment as they regarded it more informative, but not too burdensome. Conclusion The newly developed one-week AA of the EQ-5D-5L captures within-day and day-to-day health fluctuations in people with MS. From the patients’ perspective, it is a feasible and face valid way to provide important information beyond what is captured by the standard EQ-5D-5L.

Marina Otten, Matthias Augustin German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, GermanyCorrespondence: Marina OttenGerman Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, GermanyTel +49 40 7410 55428Fax +49 40 7410 55348Email m.otten@uke.deBackground and Objectives: This article presents patients’ attitudes about documenting patient data and outcome measures in psoriasis clinical practice to support a Delphi approach of psoriasis experts to develop a standard data set.Patients and Methods: We conducted three focus groups with 14 patients in a German outpatient unit for psoriasis. The focus was to explore reasons for and against the documentation of single variables concerning personal, anamnesis, clinical, patient-reported outcomes, and other data.Results: The patients mainly discussed if a variable has an impact on the disease or treatment decision, or if there might be a practical value from experiences with treatments when documented. In addition, in their point of view, patient-reported outcome data are important to document as it enables physicians to learn about a patient’s subjective burden of disease. Patient education and the involvement of other physicians in the treatment process also emerged as relevant aspects.Conclusion: The results help to understand patients’ preferences on documenting patient data and their idea of an exhaustive doctor–patient consultation to improve doctor–patient communication, disease monitoring, and quality of care.Keywords: psoriasis, patient involvement, focus groups, documentation, patient data

Teledermatology is a rapidly developing field of dermatological care, giving the opportunity to deliver more efficient healthcare to patients in remote areas. Live interactive (LI) teledermatology uses videoconferencing and, hence, allows for direct communication. A current overview on effectiveness, costs, feasibility and accuracy of LI applications compared to standard care is missing. The present systematic review provides this overview on LI teledermatology. Two databases were searched until April 2019, followed by title, abstract and full-text screening. Additionally, reference lists of the detected eligible articles were screened for further eligible studies. Studies comparing LI applications with standard care were included. Data on study design, sample size, country, objectives, main findings and characteristics of LI applications were extracted. Results on time effectiveness, costs, accuracy and feasibility of LI applications were synthesized. Additionally, the quality of included studies was assessed. Twenty-three publications were included in the final analysis: seventeen case-control studies and six randomized controlled trials. Included studies were published between 1997 and 2017. Study quality differed across studies. The studies were carried out in eight different countries. Eleven studies focused on patient consultation, three on patient organization and nine on combined applications of the aforementioned. Nine studies investigated applications facilitating patient-provider interaction. Fourteen studies evaluated applications combining patient-provider and provider-provider interaction, meaning the patient sits next to one provider while using LI applications to interact with another provider. This review reveals that LI applications can be a time effective substitute of or supplement to standard dermatological care. Results demonstrated that LI and standard care are comparable with regard to feasibility and accuracy. No clear tendencies can be reported with regard to costs. However, there is a lack of current comparative studies.

BACKGROUND With increasing digitalization and the current pandemic, teledermatology has gained importance in German-speaking countries in recent years. The regulation on remote consultation methods was recently relaxed, allowing for a more widespread introduction of teledermatological health care services. OBJECTIVE The aim of this work is to evaluate a store-and-forward (SAF) teledermatology application from the patients’ and physicians’ perspectives. METHODS We carried out a noncontrolled user survey of the web-based platform derma2go in the course of the remote consultation by German dermatologists. Through the platform, patients with dermatological requests could obtain expert advice within a few hours after entering their medical history and uploading photographs of their skin lesions. RESULTS A total of 1476 (t1) and 361 (t2) patients and 2207 dermatologist ratings were included within the evaluation. A large proportion of participants were satisfied with the application (t1=83.9%; t2=81.2%). Most participants also rated the usability as high (t1=83.0% satisfied) and were satisfied with the response time of the dermatologists (t1=92.0% satisfied). In addition, a large majority agreed with the statement that they trusted the web-based application (t1=90.5%). At t2, 20.0% of those who participated stated that their skin problem had healed; for 49.8% of participants, it had already improved; for 22.0% of participants, it was unchanged; and for 3.5% of participants, skin problems had worsened. For 64.0% of users, the request was completely resolved, and for 24.2% or users, it was partly resolved as result of the consultation. For 79.7% of users, no additional information was needed by the participating dermatologists. From the practitioners’ perspective, 71.2% of all requests were completely resolved and 24.7% were partly resolved. CONCLUSIONS Our evaluation has shown that SAF applications, exemplified by derma2go, are likely to improve access to dermatological care, with a high patient satisfaction and a high rate of resolved requests, from the patients’ and physicians’ perspectives. In the future, teledermatological SAF applications can represent a supplement to the existing routine care in dermatology. The indications, patient groups, and use cases, for which the application is particularly suitable, will be determined in further studies.

Brochures are a useful supplement to patient education. There is increasing evidence that they are an effective medium to support patient satisfaction, adherence, and empowerment. This study aims to produce reliable data on how much patients with venous leg ulcer (VLU) may profit from a brochure that focuses on VLU and on measures and aims of the related compression therapy. The evaluation took part from October 2018 until March 2019 and included 136 patients with VLU and related compression therapy. They were randomly sorted into a case group and a control group of 68 patients each. The case group received a brochure about venous disease and compression therapy and filled in a questionnaire after reading. The questions ranged from basic knowledge about VLU and compression therapy to aspects of self‐care. The control group answered the same questions without previous reading of the brochure. The results show that in almost every aspect, the patients in the case group were better informed about their diseases, the compression therapy, and how they may support the measures adequately. This study suggests that patients with VLU may profit from a brochure that explains their disease and the related compression therapy. Better knowledge and understanding may strengthen their empowerment and adherence.

Background With increasing digitalization and the current pandemic, teledermatology has gained importance in German-speaking countries in recent years. The regulation on remote consultation methods was recently relaxed, allowing for a more widespread introduction of teledermatological health care services. Objective The aim of this work is to evaluate a store-and-forward (SAF) teledermatology application from the patients’ and physicians’ perspectives. Methods We carried out a noncontrolled user survey of the web-based platform derma2go in the course of the remote consultation by German dermatologists. Through the platform, patients with dermatological requests could obtain expert advice within a few hours after entering their medical history and uploading photographs of their skin lesions. Results A total of 1476 (t1) and 361 (t2) patients and 2207 dermatologist ratings were included within the evaluation. A large proportion of participants were satisfied with the application (t1=83.9%; t2=81.2%). Most participants also rated the usability as high (t1=83.0% satisfied) and were satisfied with the response time of the dermatologists (t1=92.0% satisfied). In addition, a large majority agreed with the statement that they trusted the web-based application (t1=90.5%). At t2, 20.0% of those who participated stated that their skin problem had healed; for 49.8% of participants, it had already improved; for 22.0% of participants, it was unchanged; and for 3.5% of participants, skin problems had worsened. For 64.0% of users, the request was completely resolved, and for 24.2% or users, it was partly resolved as result of the consultation. For 79.7% of users, no additional information was needed by the participating dermatologists. From the practitioners’ perspective, 71.2% of all requests were completely resolved and 24.7% were partly resolved. Conclusions Our evaluation has shown that SAF applications, exemplified by derma2go, are likely to improve access to dermatological care, with a high patient satisfaction and a high rate of resolved requests, from the patients’ and physicians’ perspectives. In the future, teledermatological SAF applications can represent a supplement to the existing routine care in dermatology. The indications, patient groups, and use cases, for which the application is particularly suitable, will be determined in further studies.

Background Electronic health records (EHRs) are promising tools for routine care. These applications might not only enhance the interaction between patient and physician but also support therapy management. This is crucial in complex and chronic conditions like psoriasis. However, EHRs can only unfold their full potential when being accepted by the users. Therefore, this study aims to analyse how EHRs should be designed for patients with psoriasis and to identify differences between patient subgroups. Methods We developed a questionnaire on the acceptability of EHRs based on literature research and results from focus groups. Participants completed a paper-based or electronic version of the questionnaire. We recruited participants at an outpatient clinic as well as online via patient associations and a social media platform. We analysed data using descriptive statistics and bivariate analyses applying Chi-square and Fisher’s exact test. Results The sample encompassed 187 patients with psoriasis. Data reveals that 84.4% of the participants can think of entering data into an EHR. Participants prefer entering data at home (72.2%) instead of entering data in the waiting room (44.9%) and using an own internet-ready device (laptop/computer: 62.6%; smartphone/tablet: 61.5%) instead of a provided device (46.0%). Altogether, 55.6% of participants would accept entering data on a monthly basis when this lasts between one and 10 minutes and further 27.8% would accept even longer lasting data entry. Data privacy is of great concern (e.g. patient should decide who has access to data: 96.7%). Subgroup analyses reveal differences with regard to age, educational level, burden due to psoriasis, number of internet activities, use of electronic questionnaires and mode of administration. Conclusion The high acceptance of entering data is favourable for the implementation of EHRs. The results suggest technical and structural recommendations: Differences between subgroups support the development of flexible EHRs encompassing a basic module, which is expandable with further add-ons, and compatible to different devices. Furthermore, involving patients by entering data into an EHR requires that physicians communicate open-mindedly with the patient and consider data throughout decision-making. Patients should remain owner of their own health data and decide about its processing.

Hintergrund Teledermatologische Anwendungen werden im deutschen Versorgungssystem in den nachsten Jahren erheblich an Bedeutung gewinnen. Das vorliegende Empfehlungspapier wurde als Expertenkonsens auf der Basis einer qualifizierten Literaturrecherche und eines strukturierten Entscheidungsprozesses der Autorengruppe entwickelt. ZIELSETZUNG: a) die IST-Analyse zum Einsatz der Telemedizin in der Dermatologie, b) die Bewertung der Evidenz ihres Nutzens und ihrer Sicherheit und, c) die Entwicklung von Verfahrensstandards fur die arztliche Praxis in den deutschsprachigen Landern. Auf der Basis dieser Erkenntnisse soll durch einen Expertenkonsens eine Handlungsorientierung fur den Einsatz der Teledermatologie gegeben werden. Methoden Dreistufiges Vorgehen: 1) Systematische Literaturrecherche in den internationalen medizinischen Onlinedatenbanken Pubmed und Embase, 2) Weitere, teils manuelle Recherchen, 3) Expertenkonsens mit einem systematischen Entscheidungsverfahren mit 21 Teilnehmern. Ergebnisse In der strukturierten Literaturrecherche fanden sich 204 wissenschaftliche Originalarbeiten, in denen Anwendungen der Telemedizin bei Hautkrankheiten thematisiert wurden. Diese wurden systematisch aufgearbeitet, analysiert und bewertet. In der zweiten Stufe wurden in einer Handsuche zusatzliche relevante Schriften identifiziert und ebenfalls ausgewertet. Das Expertengremium entwickelte dann auf der Basis der externen Evidenz sowie der internen Diskussion Handlungsempfehlungen fur die Praxis. Schlussfolgerung der wissenschaftlichen Studienlage ist, dass die telemedizinische Unterstutzung der dermatologischen Behandlung und Pravention bei Einsatz leistungsfahiger Systeme, Kenntnis ihrer Anwendung sowie Beachtung der Indikationen und Kontrainidikationen einen erheblichen Mehrnutzen darstellt. Schlussfolgerungen Die Teledermatologie hat in den deutschsprachigen Landern wie auch weltweit einen zunehmenden Stellenwert und bietet aufgrund des hohen Innovationsgrades eine Vorreiter- und Vorbildfunktion fur weitere telemedizinische Anwendungen anderer Fachrichtungen. Eine qualitatsgesicherte teledermatologische Behandlung ist in den deutschsprachigen Landern praktikabel und kann zu einem relevanten Mehrnutzen in der Versorgung fuhren. Ihr Einsatz ist immer dann in Erwagung zu ziehen, wenn relevante Zusatznutzen fur die Patienten ohne relevante Nachteile fur sie und fur die Versorgenden zu erwarten sind. Fur die teledermatologische Behandlung wurden mit dem vorliegenden Konsensuspapier praxisrelevante Masgaben festgelegt. Etwaige situationsabhangige Limitationen in der Versorgung sind stets zu beachten.

ObjectivesTo validate the newly developed Daily Experience Sampling Questionnaire (DESQ) that measures affective subjective well-being (SWB). The DESQ is an end-of-day diary in which respondents retrospectively rate their SWB at six different, randomly determined moments; it is completed over 1 week. The DESQ shall provide an alternative or complementary approach to existing methods of near-time SWB measurement (experience sampling, Day Reconstruction Method). The primary research objective was to determine criterion validity of the DESQ.DesignProspective, non-interventional study.SettingParticipants were recruited in Hamburg, Germany, at a specialised outpatient clinic (patients) and via different channels (healthy participants).Participants101 adults with diagnosed and stable psoriasis (46 women, 55 men); 105 adults without psoriasis (49 women, 56 men).Primary and secondary outcome measuresParticipants completed the DESQ for 3 weeks. In weeks 2 and 3, they also performed experience sampling. Criterion validity was determined by weekwise intraclass correlations (ICC) between both methods. Sensitivity to change was determined by the correlation between changes in both methods from weeks 2 to 3. For convergent validity, related concepts such as life satisfaction were measured. Retest reliability was determined using DESQ values of weeks 2 and 3.ResultsCriterion validity was excellent (ICC: patients=0.86, 95% CI 0.81 to 0.91; healthy participants=0.86, 95% CI 0.79 to 0.91). Sensitivity to change was r=0.57 and r=0.56, respectively. Correlations with convergent criteria were mostly significant and higher in constructs more proximal to SWB. The ICC indicating retest reliability was 0.77 in patients (95% CI 0.68 to 0.84) and 0.81 in healthy participants (95% CI 0.73 to 0.86).ConclusionsThe DESQ is a valid, reliable and feasible instrument for SWB measurement in people with psoriasis and healthy people. Its approach of end-of-day evaluations of single moments may also lend itself to the measurement of other highly time-variant constructs such as pain, fatigue or depression.

Zusammenfassung Anliegen Der Einsatz antidepressiver Kombinationsbehandlungen wurde bisher nur in wenigen Studien untersucht. Methode Die Verschreibungspraxis antidepressiver Kombinationstherapien wurde am LVR-Klinikum Düsseldorf bei Patienten mit schwerer depressiver Episode (ICD-10 F32.2 und F33.2) retrospektiv untersucht. Ergebnis Von 1198 stationären und teilstationären Fällen erhielten 25,1 % eine Kombination aus zwei oder mehr Antidepressiva. Schlussfolgerung Kombinationstherapien werden häufig eingesetzt, was einem geringen Empfehlungsgrad der Behandlungsleitlinie gegenübersteht.

In psoriasis, several patient-relevant treatment goals must be met to be able to consider a treatment beneficial. To assess treatment benefit, the validated questionnaire Patient Benefit Index (PBI) can be used. Its global score summarizes the degree of patient-relevant treatment goals achieved after treatment, weighted by their individual importance on rating scales. These treatment goals have empirically been assigned to five dimensions. While the weighting procedure of the PBI provides information about the importance patients attach to treatment goals on a rating scale from 0 to 4, methods of preference elicitation provide information on how patients would trade off certain treatment goals against each other. However, since the treatment goals defined in the PBI often overlap conceptually, the dimensions of the PBI might be more suitable for exploration in preference elicitation methods. We used an analytic hierarchy process (AHP) and a discrete choice experiment (DCE) to generate preference-based importance weights for the PBI dimensions, and compared these weights to those derived from the rating scales. We were further interested in the effect of importance weights on the calculation of the PBI score. A total of 120 patients with psoriasis completed a questionnaire at baseline, including AHP, DCE and the rating scales, and at follow-up, regarding the attainment of treatment goals, to calculate the PBI score. In contrast to the results derived from the average rating scores, use of AHP and DCE resulted in both similar importance weights and rankings of dimensions. Presumably, patients rated treatment goals differently than the respective dimension they belong to. However, the differently calculated importance weights led to similar values of the PBI score. Our findings nevertheless provide clear evidence that, regardless of the method used, the importance of treatment goals differs between psoriasis patients, and this should be reflected in treatment decisions.