Use of diagnostic tests by dermatologists, podiatrists and family practitioners in the United States: pilot data from a cross‐sectional survey

Abstract

Before treating onychomycosis, it is important to exclude other conditions such as lichen planus and psoriasis. The purpose of this study was to evaluate physician preferences and uses of diagnostic tests for toenail onychomycosis (TO) by surveying dermatologists (D), podiatrists (P) and family practitioners (FP) in the United States. Surveys were mailed to approximately 1000 randomly sampled physicians from each of the three specialities. The questionnaire consisted of 15 items regarding physician and practice characteristics, number of patients with TO seen and treated, tests used to diagnose TO and reasons for using the tests. Results were analysed using several statistical methods. Response rates were low (D33.7%; P16.6%; FP28.4%). Ds and Ps (75.2%) and FPs (43.4%) reported feeling 'very confident' at diagnosing onychomycosis. KOH was the preferred diagnostic test for all three specialities. More Ds (75.4%) felt 'very confident' interpreting potassium hydroxide (KOH) exams than Ps (24.9%) and FPs (18.5%). Use of KOH exams was statistically associated with confidence interpreting exams (P P = 0.04092; D & FP P < 0.0001). Some FPs (46.6%) and Ps (21.6%) did not obtain a confirmatory diagnostic test prior to the treatment of onychomycosis while 63.6% of Ds 'almost always/always' did. While limited by low-response rate, this study provides pilot information on the diagnostic preferences for TO by American D, P and FP.

Complementary Alternative Medicine for Children with Autism: A Physician Survey

“…The survey response-rate was low, but comparable to some other recently published physician surveys ranging from 19.5 to 28.4% (Koshnick et al 2007;Overland et al 2008;Wilson et al 2008). In a recent study, traditional random samples using the American Medical Association (AMA) Physician Masterfile yielded response rates of 29-43% (Crane et al 2008).…”

A practical application of onychomycosis cure – combining patient, physician and regulatory body perspectives

“…Despite the prevalent use of mycological testing among onychomycosis studies, there is still a need for mycological testing in clinical settings. Despite the cost savings of performing confirmatory testing prior to treatment, family practitioners almost never perform mycological tests (46.6%) while dermatologists almost always conduct a mycological test (63.5%) . This result is compounded by the fact that clinicians (excluding dermatologists and podiatrists) have a lower positive predictive value (66%) in diagnosing onychomycosis as compared to dermatologists (75%) .…”

“…Despite the cost savings of performing confirmatory testing prior to treatment, family practitioners almost never perform mycological tests (46.6%) while dermatologists almost always conduct a mycological test (63.5%). 45,68 This result is compounded by the fact that clinicians (excluding dermatologists and podiatrists) have a lower positive predictive value (66%) in diagnosing onychomycosis as compared to dermatologists (75%). 69,70 Thus, incorporating mycological testing into the definition of cure is cost effective and an aid to those not well versed in onychomycosis.…”

Onikomikoz Tanısında Kullanılan 5 Farklı Yöntemin Etkinlik ve Maliyet Karşılaştırması

“…Onikomikoz tedavisinden önce, bir tanı yöntemi ile tanının kesinleştirilmesinin maliyeti düşürdüğü daha önce gösterilmiştir 21 . Öte yandan, onikomikoz tedavisi vermeden önce hekimlerin tanı yöntemlerini kullanım oranını değerlendiren az sayıda çalışmada dermatologların ancak %60'ının bu testleri kullandığı görülmüştür 22 . Literatürde bu testlerin aile hekimliği ve pratisyen hekimlik uygulamalarında kullanımı ise dermatologlara göre çok daha düşük kalmaktadır 1,22 .…”

“…Öte yandan, onikomikoz tedavisi vermeden önce hekimlerin tanı yöntemlerini kullanım oranını değerlendiren az sayıda çalışmada dermatologların ancak %60'ının bu testleri kullandığı görülmüştür 22 . Literatürde bu testlerin aile hekimliği ve pratisyen hekimlik uygulamalarında kullanımı ise dermatologlara göre çok daha düşük kalmaktadır 1,22 . Ülkemizde bu konuda bir çalışma olmamakla beraber dermatoloji pratiğinde hasta yoğunluğu, polikliniklerde uygun laboratuvar koşullarının sağlanamaması gibi nedenlerle benzer oranlar beklenmektedir.…”