Is an online skin cancer toolkit an effective way to educate primary care physicians about skin cancer diagnosis and referral?

Gulati, Abha; Harwood, Catherine A.; Rolph, John E.; Pottinger, Elizabeth; McGregor, Jane; Goad, Nina; Proby, Charlotte M.

doi:10.1111/jdv.13167

Cited by 17 publications

(36 citation statements)

References 26 publications

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“…Likewise, three other intervention studies found that use of a CET did not reduce referrals to dermatology [ 13 , 32 , 33 ]. While reduction of referrals and other return appointments may be a clinical goal to save patient and provider time and to reduce costs, its attainment through usage of CETs has not been established.…”

Section: Discussionmentioning

confidence: 99%

“…Dermatology is an area of concern in primary care for which previous literature extensively discusses the goals of improving diagnostic accuracy, improving the management of skin disease, and reducing referrals [ 8 – 12 ]. Some studies in primary care and hospital settings show that a dermatology education tool kit [ 13 ] and diagnostic support CET [ 14 ] can improve provider confidence and diagnostic accuracy. However, few studies have examined the impact of a single CET on provider practice or patient outcomes from the provider's perspective.…”

Section: Introductionmentioning

confidence: 99%

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Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods

Burke

Savard

Rubin

et al. 2020

jmla

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Objective: Few studies have examined the impact of a single clinical evidence technology (CET) on provider practice or patient outcomes from the provider’s perspective. A previous cluster-randomized controlled trial with patient-reported data tested the effectiveness of a CET (i.e., VisualDx) in improving skin problem outcomes but found no significant effect. The objectives of this follow-up study were to identify barriers and facilitators to the use of the CET from the perspective of primary care providers (PCPs) and to identify reasons why the CET did not affect outcomes in the trial.Methods: Using a convergent mixed methods design, the authors had PCPs complete a post-trial survey and participate in interviews about using the CET for managing patients’ skin problems. Data from both methods were integrated.Results: PCPs found the CET somewhat easy to use but only occasionally useful. Less experienced PCPs used the CET more frequently. Data from interviews revealed barriers and facilitators at four steps of evidence-based practice: clinical question recognition, information acquisition, appraisal of relevance, and application with patients. Facilitators included uncertainty in dermatology, intention for use, convenience of access, diagnosis and treatment support, and patient communication. Barriers included confidence in dermatology, preference for other sources, interface difficulties, presence of irrelevant information, and lack of decision impact.Conclusion: PCPs found the CET useful for diagnosis, treatment support, and patient communication. However, the barriers of interface difficulties, irrelevant search results, and preferred use of other sources limited its positive impact on patient skin problem management.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods

Burke

Savard

Rubin

et al. 2020

jmla

View full text Add to dashboard Cite

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“…Multiple studies have examined the benefits of online learning modules for medical students as well as residents. [9][10][11][12][13] Online learning modules are an effective, preferred method of learning for providers of all educational levels. 14,15 The American Academy of Dermatology has developed 18 online learning modules focused on core competency and needs assessments of primary care physicians.…”

Section: Introductionmentioning

confidence: 99%

“…Better educated providers and a streamlined data collection system may encourage the use of teledermatology as well as reduce the number of unnecessary face‐to‐face consultations. Multiple studies have examined the benefits of online learning modules for medical students as well as residents . Online learning modules are an effective, preferred method of learning for providers of all educational levels .…”

Section: Introductionmentioning

confidence: 99%

Impact of standardized templates and skin cancer learning modules for teledermatology consultations

et al. 2019

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Background Little research has been done in teledermatology to examine the effects of standardized templates and subject‐specific learning modules. Methods We performed a prospective study examining the effects of standardized templates and standardized cutaneous oncology learning modules on teledermatology referrals at Mayo Clinic. This data was then compared to previous teledermatology referrals before standardized templates were adopted. Results A total of 42 teledermatology consultations were performed during the 4‐month study period. The use of standardized templates resulted in an absolute reduction in face‐to‐face referrals. Teledermatology consultation increased the absolute diagnostic and management concordance by 26.2% (P = 0.02) and 33.3% (P < 0.01), respectively, and decreased the absolute diagnostic and management discordance by 19.1% (P = 0.03) and 31.0% (P < 0.01), respectively. The largest knowledge gaps were identified in cutaneous oncology. Educational intervention improved theoretical referral rates and confidence in diagnosis and management overall. Conclusion The implementation of standardized intake templates reduces the rate of face‐to‐face referrals. Teledermatology improves primary care‐based dermatological care and reduces theoretical referral rates.

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“…Some studies indicate that additional dermatology knowledge, training, and diagnostic support could improve practice and patient outcomes. General practitioners in the United Kingdom who used an online source for skin cancer diagnosis information increased their diagnostic accuracy and confidence, but referrals were not reduced [16]. Referrals to dermatology in a Veterans Affairs hospital that lacked a specific diagnosis were reduced by an intervention that trained PCPs [17].…”

Section: Introductionmentioning

confidence: 99%

Effect of a clinical evidence technology on patient skin disease outcomes in primary care: a cluster-randomized controlled trial

Burke

Littenberg

2019

jmla

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Objective: Providers’ use of clinical evidence technologies (CETs) improves their diagnosis and treatment decisions. Despite these benefits, few studies have evaluated the impact of CETs on patient outcomes. The investigators evaluated the effect of one CET, VisualDx, on skin problem outcomes in primary care.Methods: A cluster-randomized controlled pragmatic trial was conducted in outpatient clinics at an academic medical center in the northeastern United States. Participants were primary care providers (PCPs), and their adult patients were seen for skin problems. The intervention was VisualDx, as used by PCPs. Outcomes were patient-reported time from index clinic visit to problem resolution, and the number of follow-up visits to any provider for the same problem. PCPs who were randomly assigned to the intervention agreed to use VisualDx as their primary evidence source for skin problems. Control group PCPs agreed not to use VisualDx. Investigators collected outcome data from patients by phone at thirty-day intervals. Cox proportional hazards models assessed time to resolution. Wilcoxon-rank sum tests and logistic regression compared the need for return appointments.Results: Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (hazard ratio=0.92; 95% confidence interval [CI]=0.70, 1.21; p=0.54). Patient follow-up appointments did not differ significantly between groups (odds ratio=1.26; CI=0.94, 1.70; p=0.29).Conclusion: This pragmatic trial tested the effectiveness of VisualDx on patient-reported skin disease outcomes in a generalizable clinical setting. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx.

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Is an online skin cancer toolkit an effective way to educate primary care physicians about skin cancer diagnosis and referral?

Cited by 17 publications

References 26 publications

Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods

Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods

Impact of standardized templates and skin cancer learning modules for teledermatology consultations

Effect of a clinical evidence technology on patient skin disease outcomes in primary care: a cluster-randomized controlled trial

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