Evaluation of Point-of-Care Decision Support for Adult Acne Treatment by Primary Care Clinicians

Abstract

cne is a chronic inflammatory skin disease that affects more than 85% of adolescents and frequently continues to adulthood. [1][2][3][4] Although there is a high diagnostic concordance for acne between dermatologists and primary care clinicians, acne continues to be a common indication for referral to a dermatologist. 5,6 Although referrals to dermatologists for acne are not discouraged, there are consequences of immediate referral by primary care clinicians who do not provide treatment, including delayed treatment and loss to follow-up. 7 Previous studies have demonstrated the potential of education and treatment algorithms to reduce unnecessary referrals to specialty care in nondermatological disease areas. [8][9][10][11][12] Importantly, these studies support the use of real-time decision-support tools to modify physician behavior and reduce unnecessary referrals, specifically for patients with pediatric scoliosis or constipation being referred to specialists by primary care clinicians. 9,10 Meanwhile, decision-support tools have also been used to improve rates of health screening questions for preventative health and laboratory test orders for monitoring of adverse drug events. 11,12 In dermatology, stepwise treatment algorithms for acne have been proposed, although implementation has been a challenge. [13][14][15] In a previous study, 7 we modeled the effect of algorithm-based acne treatment by primary care clinicians, and demonstrated shared acne care had the potential to decrease the rates of unnecessary appointments, wait time for treatment, no-show rates, and downstream costs associated with acne. Despite these predictions, prospective evaluation of algorithm-based care for acne is lacking. From a societal standpoint, shared care may reduce unnecessary referrals for acne while reallocating resources to improve access to dermato-IMPORTANCE Acne is a common reason for referral to dermatologists from primary care clinicians. We previously modeled the impact of algorithm-based acne care in reducing dermatology referrals, missed appointments, and treatment delays. OBJECTIVE To prospectively evaluate the downstream outcomes following a real-time, algorithm-based electronic decision-support tool on the treatment of patients referred for acne. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study included 260 treatment-naive patients referred to a dermatologist for the chief concern of acne, as well as the referring primary care clinicians, at 33 primary care sites affiliated with Brigham and Women's Hospital from March 2017 to March 2018. INTERVENTIONSWe developed and implemented a decision-support tool into the electronic medical record system at an academic medical center. The algorithm identified patients referred to a dermatologist who had not previously been treated for acne and offered guideline-based recommendations for treatment via a real-time notification. MAIN OUTCOMES AND MEASURES Treatment modification by referring clinicians.RESULTS Of 260 patients referred for acne, 209 (80.4%) were wome...

Effect of dermatological consultation on survival in patients with checkpoint inhibitor‐associated cutaneous toxicity

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Prospective and randomized comparative study of calcium hydroxylapatite vs calcium hydroxylapatite plus HIFU in treatment of moderate‐to‐severe acne scars

“…Managing acne scars is a challenge, 7‐10 and therapies are divided into nonsurgical and surgical. The former includes anti‐acne agents, 11,12 chemical peels, 13 microneedling, 14‐17 and ablative 18 and nonablative fractional 19‐22 and nonfractional 23 lasers, as well as autologous growth factors 24‐27 .…”