Validating the diagnostic code for acne in a tertiary care dermatology centre

Ejaz, Aiza; Malaiyandi, Viba; Kim, Whan Ben; Rogalska, Tetyana; Alhusayen, Raed

doi:10.1684/ejd.2015.2606

Cited by 12 publications

(9 citation statements)

References 8 publications

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“…We chose to focus on psoriasis, hidradenitis suppurativa, acne, and alopecia areata as they are (1) common dermatologic conditions, (2) associated with important systemic and mental health comorbidities, and (3) their identification in large databases using International Classification of Disease codes has been previously validated. 14 , 15 , 16 Provider specialty was classified using provider taxonomy codes associated with the clinical encounter claims. The primary care specialties were defined as pediatrics, internal medicine, and family medicine.…”

Section: Methodsmentioning

confidence: 99%

Use of primary care services among patients with chronic skin disease seen by dermatologists

et al. 2021

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Background: Skin diseases, such as psoriasis, hidradenitis suppurativa, acne, and alopecia areata, have increasingly been linked to systemic and mental health comorbidities, such as depression. Although identification and management of these comorbidities is typically a part of primary care, some patients might not have an established relationship with a primary care provider and may only be seeing their dermatologist. Objective: To examine the frequency with which dermatologists are the main contact within a health care system for patients with these chronic skin conditions. Methods: We performed a retrospective cohort study using Optum's deidentified Clinformatics Data Mart Database. The primary outcome was the proportion of patients who established care with a dermatologist and had no encounters with a primary care provider during the subsequent year after this dermatology encounter. Results: Across each of the skin diseases evaluated, 21.6%-31.2% of men and 16.9%-26.2% of women had no primary care visits in the subsequent year after establishing care with their dermatologist. Conclusion and Relevance: For many patients with chronic skin diseases, their dermatologist might be their only source of contact with the health care system. There may be an opportunity for dermatologists to improve the quality of care for our patients by screening for associated comorbidities.

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Section: Methodsmentioning

confidence: 99%

Use of primary care services among patients with chronic skin disease seen by dermatologists

et al. 2021

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“…Previous studies have validated the accuracy of ICD codes to identify patients with acne. 13 Individual consecutive prescriptions for isotretinoin were identified to define courses of therapy. To allow for minor delays in prescribing due to logistical and other factors, prescriptions separated by fewer than 15 days were considered part of the same course of therapy.…”

Section: Study Populationmentioning

confidence: 99%

The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time

Barbieri

Shin

Wang

et al. 2020

Journal of the American Academy of Dermatology

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Background-Due to concerns about hypertriglyceridemia, liver enzyme abnormalities, and leukopenia during isotretinoin therapy for acne, patients are often followed closely with routine laboratory monitoring, although the value of this practice has been questioned.Methods-We conducted a cohort study of patients receiving isotretinoin for acne between January 1, 2008 and June 30, 2017 using the OptumInsights Electronic Health Record Database to evaluate the frequency of laboratory abnormalities. Poisson regression was used to evaluate for changes to the frequency of routine laboratory monitoring over time.Results-Among 1,863 patients treated with isotretinoin, grade 3 or greater triglyceride and liver function testing abnormalities were noted in fewer than 1% and 0.5% of patients screened, respectively. No grade 3 or greater cholesterol or complete blood count abnormalities were observed. There were no meaningful changes in the frequency of laboratory monitoring over time.Conclusions and Relevance-While laboratory abnormalities are rare and often do not influence management, frequent laboratory monitoring remains a common practice. There are opportunities to improve the quality of care among patients being treated with isotretinoin for acne

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“…Inclusion criteria were (1) female sex; (2) aged 12 to 45 years; (3) at least 1 encounter with an International Classification of Diseases, Ninth Revision ( ICD-9 ) or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision ( ICD-10 ) codes for acne; (4) prescription for a course of spironolactone of at least 30 days in duration that was started within 30 days of this encounter for acne, with the start date of the course being defined as the index date; and (5) at least 180 days of continuous enrollment in Optum Clinformatics Data Mart prior to and after the index date. Prior studies have validated the use of ICD-9 and ICD-10 codes to identify patients with acne . To account for logistical considerations and nonadherence that could result in delays between prescriptions, prescriptions separated by fewer than 30 days from the date of the prior prescription plus the number of days of medication supplied were considered to be part of the same course of therapy …”

Section: Methodsmentioning

confidence: 99%

“…Prior studies have validated the use of ICD-9 and ICD-10 codes to identify patients with acne. 12,13 To account for logistical considerations and nonadherence that could result in delays between pre-scriptions, prescriptions separated by fewer than 30 days from the date of the prior prescription plus the number of days of medication supplied were considered to be part of the same course of therapy. [14][15][16][17][18][19][20] The primary outcome was the frequency of testing baseline potassium levels (defined as potassium testing between the encounter for acne and the index date) and the frequency of monitoring potassium levels while being treated (defined as testing ordered within 180 days of index date).…”

Section: Study Populationmentioning

confidence: 99%

Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone

2021

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IMPORTANCEAlthough recent studies and guideline recommendations indicate that potassium level monitoring is of low usefulness for healthy young women being treated for acne with spironolactone, little is known about whether these recommendations have been implemented in clinical practice. OBJECTIVETo evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. Participants comprised 108 547 healthy female patients aged 12 to 45 years who were treated for acne with spironolactone. MAIN OUTCOME AND MEASURESThe primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone. For clinicians who had prescribed at least 5 courses of spironolactone, the percentage of clinicians who ordered baseline potassium testing or monitoring and the percentage of clinicians who always monitored potassium were compared between 2008 and 2015 vs between 2016 and 2018. RESULTSFor 108 547 women included in this cohort study, the mean (SD) age at the start of treatment was 30.7 (8.6) years, and the mean (SD) course duration was 159 (218) days. Between 2008 and 2018, the percentage of women whose potassium levels were monitored within 180 days of starting spironolactone by all clinicians decreased from 41.4% to 38.5%, with a decrease from 48.9% to 41.0% among dermatologists and from 39.7% to 37.7% among internists but with an increase from 71.4% to 75.4% among advanced practice clinicians (ie, nurse practitioners and physician assistants). The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%).CONCLUSIONS AND RELEVANCE Despite increasing evidence and guidelines supporting the elimination of potassium monitoring among healthy young women treated for acne with spironolactone, the present study findings suggest that potassium monitoring remains common, with substantial variability in clinician practices. There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap.

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Validating the diagnostic code for acne in a tertiary care dermatology centre

Cited by 12 publications

References 8 publications

Use of primary care services among patients with chronic skin disease seen by dermatologists

Use of primary care services among patients with chronic skin disease seen by dermatologists

The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time

Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone

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