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Chu CY, Bhat Marne R, Cheung CMT, Diep LN, Noppakun N, Novianto E, Palmero MLH, Tay YK, Zalmy AN. Advanced Systemic Treatments in Patients with Moderate-to-Severe Atopic Dermatitis: Key Learnings from Physicians Practicing in Nine Asian Countries and Territories. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01278-x. [PMID: 39340696 DOI: 10.1007/s13555-024-01278-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Rapid progress made in the management of atopic dermatitis (AD) in recent years and the differences in patient journey between Asian and non-Asian populations call for a review of current atopic dermatitis landscape in Asia. METHODS A roundtable meeting with nine regional dermatological experts was held in June 2023 to discuss the optimal management approaches for moderate-to-severe AD, focusing on the use of advanced therapies. RESULTS Disease burden on patients' quality of life, treatment adherence, and financial constraints were identified as major concerns when managing patients with moderate-to-severe AD in parts of Asia. It was agreed that the Hanifin and Rajka's criteria or the UK Working Party's Diagnostic Criteria for Atopic Dermatitis can be used to guide the clinical diagnosis of AD. Meanwhile, patient-reported outcome scales including the Dermatology Life Quality Index and Atopic Dermatitis Control Tool can be used alongside depression monitoring scales to monitor treatment outcomes in patients with AD, allowing a better understanding for individualized treatment. When managing moderate-to-severe AD, phototherapy should be attempted after failure with topical treatments, followed by conventional disease-modifying antirheumatic drugs and, subsequently, biologics or Janus kinase inhibitors. Systemic corticosteroids can be used as short-term therapy for acute flares. Although these advanced treatments are known to be effective, physicians have to take into consideration safety concerns and limitations when prescribing these treatments. CONCLUSIONS Treatments in AD have evolved and its management varies country by country. Unique challenges across Asian countries necessitate a different management approach in Asian patients with AD.
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
| | - Ramesh Bhat Marne
- Department of Dermatology, Venereology, and Leprosy, and Head of Research, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India
| | - Christina Man-Tung Cheung
- Division of Dermatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Le Ngoc Diep
- Department of Dermatology, Ho Chi Minh City University of Medicine and Pharmacy and Ho Chi Minh City University Medical Center - Branch 2, Ho Chi Minh City, Vietnam
| | - Nopadon Noppakun
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Endi Novianto
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta Pusat, Indonesia
| | | | - Yong-Kwang Tay
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Azizan Noor Zalmy
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur and Thomson Hospital Kota Damansara, Selangor, Malaysia
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Hagenström K, Müller K, Ohm F, Augustin M. Epidemiology and health care of hyperhidrosis in Germany: claims data analysis. BMJ Open 2024; 14:e085862. [PMID: 39134433 PMCID: PMC11331909 DOI: 10.1136/bmjopen-2024-085862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Data on the population-based epidemiology of hyperhidrosis (HH) are scarce. This study investigated the epidemiology and healthcare of HH in Germany. DESIGN AND SETTING Claims data of adult persons insured by a German statutory health insurance (DAK-Gesundheit) between 2016 and 2020 were analysed. Included were persons aged 18 years and older with a diagnosis of HH (confirmed inpatient or outpatient diagnosis in the observation year) who were continuously insured. Following outcomes were measured: prevalence and incidence rates, severity of hyperhidrosis and inpatient and outpatient care by a group of specialists. RESULTS In 2020, 0.70% of insured adults were confirmed to have HH (mean age 59.5 years, SD 18.9, 61.6% female), with 9.24% having a 'localised' form, 8.65% a 'generalised' form and 84.80% an 'unspecified' form. 0.04% of the total population had a severe form. The incidence was 0.35%. Localised HH was more common in younger age groups (18 to <30 years), while older age groups (70 to <80 years) were significantly more likely to suffer from generalised HH. Systemic anticholinergics were used in 4.55%, and botulinum toxin injection therapy in 0.81%. General practitioners were most frequently involved in care. Inpatient stays due to HH were very rare, with 0.14% in 2019 and 0.04% in 2020. CONCLUSION Multisource data analysis connecting primary and secondary data will be needed for a complete picture of the healthcare and epidemiology of HH.
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Affiliation(s)
- Kristina Hagenström
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Müller
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Frenz Ohm
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Di Raimondo C, Lozzi F, Di Domenico PP, Paganini C, Campione E, Galluzzo M, Bianchi L. Blastic Plasmacytoid Dendritic Cell Neoplasm, from a Dermatological Point of View. Int J Mol Sci 2024; 25:7099. [PMID: 39000208 PMCID: PMC11240932 DOI: 10.3390/ijms25137099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is an aggressive hematological malignancy derived from the precursors of plasmacytoid dendritic cells. Although disease awareness has increased over time, BPDCN represents a rare disease with an aggressive clinical course and a dismal prognosis. Due to the overlap in clinical and histological features with a large spectrum of inflammatory and neoplastic diseases, BPDCN is difficult to diagnose. Furthermore, given the rarity of the disease, treatment options for BPDCN are limited, sometimes changing by practitioner and hospitals. Treatment options range from conventional chemotherapy to the recently approved biologic agent tagraxofusp and stem cell transplantation. Therefore, a multidisciplinary approach with coordination among dermatologists, pathologists, and hematologists is ultimately imperative to reach the correct diagnosis and management of BPDCN.
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Affiliation(s)
- Cosimo Di Raimondo
- Dermatology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy (L.B.)
| | - Flavia Lozzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Claudia Paganini
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Elena Campione
- Dermatology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy (L.B.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Marco Galluzzo
- Dermatology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy (L.B.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy (L.B.)
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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4
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Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, Stratigos A, Trakatelli M, Puig L. The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:17-24. [PMID: 37806003 DOI: 10.1111/jdv.18916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The journey of patients with skin diseases through healthcare has been scarcely investigated. OBJECTIVE To analyse the journey of people with skin diseases in the different healthcare environment in Europe. METHODS This multinational, cross-sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. RESULTS On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. CONCLUSION The analysis of the self-reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.
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Affiliation(s)
- Marie Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life Aix Marseille University, Dermatology Department, University Hospital Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Carle Paul
- INSERM Infinity U1291, Université de Toulouse et CHU, Toulouse, France
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | | | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Trakatelli
- Second Dermatology Department, Faculty of Medicine, Aristotle University, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Alotaibi HM, Alruwaili ZM, Dilli AA, Altaleb AA, Asiri MM, Alwadani OJ, Alshaalan ZM, Dar UF. Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study. Healthcare (Basel) 2023; 11:1705. [PMID: 37372823 DOI: 10.3390/healthcare11121705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Primary care physicians (PCPs) are the first line of defense for the management of common dermatological conditions (DCs). This study aimed to assess how dermatological diseases are identified, managed, and referred to in primary healthcare centers (PHCs). This was a mixed methods study comprising a cross-sectional survey and semi-structured interviews recruited through PHCs across the Jouf region of Saudi Arabia. Sixty-one PCPs completed the data, and eight participants were interviewed. A survey based on a sample of 22 photographs of common DCs in the Kingdom was administered to the participants to answer questions about the correct diagnosis, appropriate management, referral strategy, and encounter rate. In our sampled population, the mean overall knowledge level on a scale of 10 was 7.08 (±1.3). Among participants that had good to acceptable scores, 51 (83.6%) were in the overall knowledge parameter, 46 (75.4%) in the diagnosis parameter, and 49 (80.3%) in the management parameter. PCPs with five years or more of experience were found to have significantly higher overall knowledge and management scores. Most of our PCPs demonstrated sufficient knowledge of common DCs and had good to acceptable scores in all parameters. However, educational and regulatory aspects of PCPs' clinical management were identified. Focused training, provision of workshops, and improving medical school curricula regarding common DCs are recommended.
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Affiliation(s)
- Hatem M Alotaibi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Ahmed A Dilli
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | | | - Mohanad M Asiri
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Osama J Alwadani
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ziad M Alshaalan
- Division of Dermatology, Department of Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
| | - Umar-Farooq Dar
- Department of Family & Community Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
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Abstract
Skin conditions are one of the most common chief complaints encountered in the primary care setting. Primary care providers (PCPs) may not have not received enough exposure and education on dermatologic conditions. Of all skin conditions, atopic dermatitis, acne vulgaris, cellulitis/abscess, verruca vulgaris, and benign skin lesions are typically the most common to present in the primary care setting. PCPs must be well educated on these topics and confident in their diagnostic and management skills. This article reviews the five most common skin conditions encountered in primary care so that PCPs can reduce the number of referrals to dermatology for conditions that can easily be managed by PCPs.
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Willems A, Tapley A, Fielding A, Tng V, Holliday EG, van Driel ML, Ball JI, Davey AR, FitzGerald K, Spike NA, Magin PJ. General Practice Registrars' Management of and Specialist Referral Patterns for Atopic Dermatitis. Dermatol Pract Concept 2021; 11:e2021118. [PMID: 33614210 DOI: 10.5826/dpc.1101a118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
Background Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP registrars. Objectives We aimed to explore the prevalence and associations of GP registrar referrals to specialists for AD management. Methods A cross-sectional analysis utilizing data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study that documents in-consultation clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors associated with referrals for AD were established using logistic regression. Results A total of 2,783 registrars (96% response rate) provided data from 381,180 consultations from 2010 to 2019. A total of 3,285 (0.55%) of 595,412 diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% to pediatricians. Associations of referral included registrar female gender, patient age, longer consultation duration; an established (rather than new) AD diagnosis; supervisor advice being sought; and learning goals being generated. Conclusions Both registrar and patient factors influence AD referral patterns. Registrars referred established rather than newly diagnosed AD, suggesting a level of comfort in initial management. Referral was associated with longer consultations, seeking supervisor advice, and generation of learning goals-suggesting these are more complex presentations and, possibly, registrar learning opportunities. A significant proportion of referrals were to non-dermatologist specialists. The implication of this for optimal patient care is a subject for further study.
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Affiliation(s)
- Anneliese Willems
- Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, VIC, Australia.,The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia
| | - Amanda Tapley
- The University of Newcastle, School of Public Health and Medicine, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Alison Fielding
- The University of Newcastle, School of Public Health and Medicine, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Vivian Tng
- Department of Dermatology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Elizabeth G Holliday
- The University of Newcastle, School of Public Health and Medicine, Callaghan, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD, Australia
| | - Jean I Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Andrew R Davey
- The University of Newcastle, School of Public Health and Medicine, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
| | - Kristen FitzGerald
- University of Tasmania, School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia
| | - Neil A Spike
- Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, VIC, Australia.,The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia
| | - Parker J Magin
- The University of Newcastle, School of Public Health and Medicine, Callaghan, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Newcastle, NSW, Australia
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8
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Makaula PU, Chateau AV, Hift RJ, Dlova NC, Mosam A. The impact of basic dermatology education and training on primary healthcare providers in KwaZulu-Natal, South Africa. S Afr Fam Pract (2004) 2021; 63:e1-e5. [PMID: 33567838 PMCID: PMC8378187 DOI: 10.4102/safp.v63i1.5200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/03/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background Dermatological diseases are amongst the commonest reasons for consultation at primary care level. Yet, dermatology teaching in medical and nursing curricula is inconsistent and often insufficient to enable medical and nursing professionals to manage these conditions effectively. Methods We tested the knowledge of 100 doctors and 195 nurses who attended dermatology training sessions held in three health districts in the province of KwaZulu-Natal (KZN), South Africa, by using a quasi-experimental uncontrolled before-and-after study design. At the start of the session, participants were exposed to 15 slides representing common dermatological conditions; this was followed by a test. The participants then attended a series of short lectures followed by the same test. Pre- and post-intervention test scores were compared, and the results were analysed by professional status, health district and type of facility. Results The mean (standard deviation [SD]) pre-intervention test score was 40.6% (20.5%). Doctors scored significantly higher than nurses (p < 0.0001). There were significant differences in performance by district (p < 0.001) and type of facility (p < 0.001). The mean (SD) post-intervention score improved to 68.7% (22.5%). Conclusion Doctors and nurses working in the primary care sector appear to be insufficiently trained in the management of common dermatological conditions. A short period of in-service training resulted in an immediate, significant improvement in knowledge, although we did not study long-term retention beyond this. We recommend improved prequalification training in dermatology in medical and nursing schools and an expansion of continuing professional development as well as in-service training opportunities for primary care practitioners.
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Affiliation(s)
- Pumeza U Makaula
- Department of Dermatology, School of Clinical Medicine, University of KwaZulu-Natal, Durban.
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9
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Chandy NP, Kaimal RS. Pediatric skin diseases in primary care: Diagnostic dilemmas a primary physician may face. J Family Med Prim Care 2020; 9:5066-5069. [PMID: 33209848 PMCID: PMC7652169 DOI: 10.4103/jfmpc.jfmpc_761_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 11/04/2022] Open
Abstract
Dermatology is an area that appears at the top of general practitioners (GPs)' educational needs. Our curriculum in undergraduate classes is inadequate to equip us for the real clinical scenarios. Pediatric skin conditions pose a special dilemma to primary care practitioners. On the one hand, dermatologic problems are so common in childhood that the primary care physician is forced to become involved with many of them. On the other hand, the scope of dermatologic conditions found in children is so broad as to be beyond the skills of most primary care physicians. The secret to managing dermatologic problems in children within a primary care setting is to recognize that a relatively small group of conditions encompass the vast majority of reasons for which a primary care physician will be consulted. By recognizing those conditions and becoming expert in the treatment of these well-defined areas, the primary care physician can manage these better. Diagnosing pediatric skin conditions and recognizing the importance of early referral of the cases that fall outside one's expertise is an important measure of the primary care physician's competence as seen by patients and their families. In this article, I would like to highlight few pediatric dermatological cases that came to our family medicine clinic, where correct diagnosis and treatment led to good outcomes.
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Affiliation(s)
- Navina P Chandy
- Department of Family Medicine, Lourdes Hospital, Kochi, Kerala, India
| | - Resmi S Kaimal
- Department of Family Medicine, Lourdes Hospital, Kochi, Kerala, India
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10
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The content and conduct of GP consultations for dermatology problems: a cross-sectional study. Br J Gen Pract 2020; 70:e723-e730. [PMID: 32895240 PMCID: PMC7480176 DOI: 10.3399/bjgp20x712577] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/02/2020] [Indexed: 01/16/2023] Open
Abstract
Background Skin complaints are common in primary care, and poor outcomes in long-term conditions are often due to low adherence to treatment. Shared decision making and self-management support may help, yet there is little understanding of patient involvement or the support provided by GPs. Aim To describe the content of primary care consultations for skin problems, including shared decision making practice, delivery of self-management advice, and follow-up. Design and setting Cross-sectional study of video-recorded UK adult GP consultations and linked data. Method A coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale. Results A total of 45/318 consultations (14.2%) related to one or more skin problems, which were discussed alongside other problems in 71.1% (32/45) of consultations. Of the 100 different problems discussed in these consultations, 51 were dermatological. The mean amount of time spent on skin problems in the consultations was 4 minutes 16 seconds. Medication was recommended for 66.7% (34/51) of skin problems, with low shared decision making (mean OPTION5 score = 10.7). Self-management advice (verbal only) was given for 47.1% (24/51) of skin problems. Most skin problems (84.3%; 43/51) were not referred to secondary care; 32.6% (14/43) of the skin problems not referred were seen again in primary care within 12 weeks, of which 35.7% (5/14) follow-up appointments were not planned. Conclusion In this study, skin problems were usually presented alongside other complaints and resulted in a medication recommendation. Shared decision making was uncommon and self-management advice not consistently given, with re-attendance for the same problem common. GPs’ training should reflect how frequently skin problems are seen and seek to improve patient involvement in decision making and support self-management.
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11
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Singhal RR, Talati KN, Gandhi BP, Shinde MK, Nair PA, Phatak AG. Prevalence and Pattern of Skin Diseases in Tribal Villages of Gujarat: A Teledermatology Approach. Indian J Community Med 2020; 45:199-203. [PMID: 32905082 PMCID: PMC7467180 DOI: 10.4103/ijcm.ijcm_76_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/26/2019] [Indexed: 11/04/2022] Open
Abstract
Background The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes. Objectives The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology. Materials and Methods A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June-August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp. Results A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor. Conclusion Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.
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Affiliation(s)
- Rochit Rajesh Singhal
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Kandarp Narendra Talati
- Department of Interdisciplinary Research, Foundation for Diffusion of Innovations, Vadodara, Gujarat, India
| | | | - Mayur Kiran Shinde
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Pragya A Nair
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
| | - Ajay Gajanan Phatak
- Central Research Services, Charutar Arogya Mandal, Karamsad, Anand, Gujarat, India
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12
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Burke MD, Savard LB, Rubin AS, Littenberg B. Barriers and facilitators to use of a clinical evidence technology in the management of skin problems in primary care: insights from mixed methods. J Med Libr Assoc 2020; 108:428-439. [PMID: 32843874 PMCID: PMC7441913 DOI: 10.5195/jmla.2020.787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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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Affiliation(s)
- Marianne D Burke
- , Associate Professor of Libraries, Emerita, Dana Medical Library, University of Vermont, Burlington, VT
| | - Liliane B Savard
- , Associate Faculty, Rehabilitation and Movement Science, Clinical and Translational Science, University of Vermont, Burlington, VT
| | - Alan S Rubin
- , Associate Professor, Department of Medicine, University of Vermont, Burlington, VT
| | - Benjamin Littenberg
- , Professor of Medicine, General Internal Medicine Research, Larner College of Medicine, University of Vermont, University of Vermont Medical Center, Burlington, VT
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Martens H, Steijlen PM, Ruwaard D. Reorganising dermatology care: predictors of the substitution of secondary care with primary care. BMC Health Serv Res 2020; 20:510. [PMID: 32503509 PMCID: PMC7275501 DOI: 10.1186/s12913-020-05368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/26/2020] [Indexed: 01/18/2023] Open
Abstract
Background The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Herm Martens
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Peter M Steijlen
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
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14
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Cowdell F. Knowledge mobilisation: an ethnographic study of the influence of practitioner mindlines on atopic eczema self-management in primary care in the UK. BMJ Open 2019; 9:e025220. [PMID: 31350238 PMCID: PMC6661925 DOI: 10.1136/bmjopen-2018-025220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To explore how atopic eczema specific mindlines are developed by primary care practitioners. DESIGN Ethnographic study. SETTING One large, urban general practice in central England. PARTICIPANTS In observation, all practitioners and support staff in the practice and in interviews a diverse group of practitioners (n=16). RESULTS Observation of over 250 hours and interview data were combined and analysed using an ethnographic approach through the lenses of mindlines and self-management. Three themes were identified: beliefs about eczema, eczema knowledge and approaches to self-management. Eczema mindlines are set against a backdrop of it being a low priority and not managed as a long-term condition. Practitioners believed that eczema is simple to manage with little change in treatments available and prescribing limited by local formularies. Practice is largely based on tacit knowledge and experience. Self-management is expected but not often explicitly facilitated. Clinical decisions are made from knowledge accumulated over time. Societal and technological developments have altered the way in which practitioner mindlines are developed; in eczema, for most, they are relatively static. CONCLUSIONS The outstanding challenge is to find novel, profession and context-specific, simple, pragmatic strategies to revise or modify practitioner mindlines by adding reliable and useful knowledge and by erasing outdated or inaccurate information thus potentially improve quality of eczema care.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
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15
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O'Doherty J, Hannigan A, Hickey L, Cullen W, O'Gorman C, O'Connor R, Glynn L, O'Neill E, O'Regan A. An analysis of childhood consultations in general practice: a multi-practice study. Ir J Med Sci 2019; 188:1239-1244. [PMID: 30746587 DOI: 10.1007/s11845-019-01982-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The majority of illnesses in children are managed by general practitioners (GPs) and there is a need for up to date data on consultations with children in order to improve healthcare service planning and allocation of resources. AIMS To investigate the presenting symptoms, diagnoses and actions taken by the GP at consultations with children in general practice. METHODS Senior medical students on general practice placement and their GP supervisors used practice management software to collect data on 100 randomly selected patients aged between 12 months and 14 years of age in each practice. Presenting symptoms, diagnoses and actions taken by the GP for the most recent attendance in the previous 12 months were summarised by age group (1-4 years; 5-10 years; 11-14 years). RESULTS Data were collected from 5959 patients at 64 practices. During the 12-month study, 3241 (54%) of children had a consultation with their GP. The most common presenting symptoms were respiratory (1-4 yrs, 28%; 5-10 yrs, 39%; 11-14 yrs, 32%) and skin complaint (1-4 yrs, 13%; 5-10 yrs, 16%; 11-14 yrs, 21%). The most common actions for all age groups were prescribing (1-4 yrs, 55%; 5-10 yrs, 58%; 11-14 yrs, 56%) and providing reassurance (1-4 yrs, 53%; 5-10 yrs, 51%; 11-14 yrs, 48%). Rates of referral and requiring further investigation increased with age. CONCLUSION This study provides a comprehensive snapshot of what children commonly present with in general practice, common diagnoses and the actions taken by GPs. The findings will help GPs to organise their practice systems and will inform healthcare service planners.
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Affiliation(s)
- Jane O'Doherty
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland.
| | - Ailish Hannigan
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
| | | | - Walter Cullen
- Urban General Practice, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Clodagh O'Gorman
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
| | - Ray O'Connor
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
| | - Liam Glynn
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
| | - Eimear O'Neill
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
| | - Andrew O'Regan
- University of Limerick Graduate Entry Medical School, Castletroy, Limerick, Ireland
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