Diagnosing skin disease in primary care: a qualitative study of GPs’ approaches: Table 1.

Rübsam, Marie-Luise; Esch, Maximilian; Baum, Erika; Bösner, Stefan

doi:10.1093/fampra/cmv056

Cited by 27 publications

(28 citation statements)

References 21 publications

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“…2 Historically, dermatology training for GPs has been limited, 2,3 with GPs lacking confidence in diagnosing and managing skin conditions. 4,5 Long-term skin problems can place a heavy burden on patients, including impaired health-related quality of life, reduced occupational productivity, and a high socioeconomic and psychological impact. 6 Although most patients with the inflammatory skin problems of eczema, psoriasis, and acne have disease of mild to moderate severity, they require high levels of self-management.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The content and conduct of GP consultations for dermatology problems: a cross-sectional study

Roux¹,

Edwards²,

Sanderson

et al. 2020

Br J Gen Pract

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BackgroundSkin 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.AimTo 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 settingCross-sectional study of video-recorded UK adult GP consultations and linked data.MethodA coding tool was developed and applied to all consultations with skin problems. Shared decision making was assessed using the observer OPTION5 scale.ResultsA 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.ConclusionIn 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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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The content and conduct of GP consultations for dermatology problems: a cross-sectional study

Roux¹,

Edwards²,

Sanderson

et al. 2020

Br J Gen Pract

View full text Add to dashboard Cite

show abstract

“…Furthermore, the clear provision of advice from specialists to GPs when specialists refer patients back to GPs could contribute to a learning effect among GPs regarding the diagnosis or treatment of dermatology patients and whether to refer to PC+ or outpatient hospital care [44]. This feedback could contribute to bridging the knowledge gap between primary and secondary care [29].…”

Section: Discussionmentioning

confidence: 99%

“…Along with media campaigns aimed at increasing awareness about the danger of skin cancer and the ageing population [28], the increase in the number of dermatologyrelated consultations will lead to a growing demand for dermatology-related healthcare services. In addition, GPs often have a lack of dermatological knowledge, which is a reason for diagnostic uncertainty and the experience of difficulties with the diagnosis and treatment of skin disease [29][30][31]. Moreover, there is large variation in GP referrals to specialised medical care, which is caused by many factors, such as uncertainty about the diagnosis, perceived seriousness of the skin disease and patient preference [32,33].…”

Section: Introductionmentioning

confidence: 99%

Reorganising dermatology care: predictors of the substitution of secondary care with primary care

Bogaart

Kroese

Spreeuwenberg

et al. 2020

BMC Health Serv Res

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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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“…In a qualitative study of PCPs' strategies for diagnosing skin problems, their preferred strategies included pattern recognition, “trying out” treatments, and referral to dermatology. Consulting research-based literature or online sources was seldom used as a strategy [ 31 ]. In our study, nearly half of PCPs in the CET arm reported using VisualDx with most of their patients with skin problems, and they frequently used other evidence sources if they were convenient.…”

Section: Discussionmentioning

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

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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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Diagnosing skin disease in primary care: a qualitative study of GPs’ approaches: Table 1.

Cited by 27 publications

References 21 publications

The content and conduct of GP consultations for dermatology problems: a cross-sectional study

The content and conduct of GP consultations for dermatology problems: a cross-sectional study

Reorganising dermatology care: predictors of the substitution of secondary care with primary care

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

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