General Practice Registrars’ Management of and Specialist Referral Patterns for Atopic Dermatitis

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 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.

Prevalence and Associations of General Practice Registrars’ Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study

“…Registrars were more likely to generate learning goals within these consultations in addition to seeking information and assistance from both supervisors and other sources. Consistent with previous studies [21,38], our findings again suggest that skin conditions remain challenging for registrars to manage.…”

Assessment of Primary Care Physicians’ Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study

“…For instance, several studies investigating PCPs’ knowledge and practice in dermatology have been carried out on various objectives, including eczema [ 12 ], topical corticosteroids [ 24 ], suspicious pigmented skin lesions [ 20 , 22 ], atopic dermatitis [ 25 ], and psoriasis [ 21 ]. At the same time, other studies evaluated the prevalence of DCs in PHC settings [ 1 , 4 , 7 , 15 , 16 , 17 ], PCPs’ knowledge [ 2 , 11 , 19 , 20 ], different approaches to management [ 18 , 21 , 22 , 23 , 24 ], and referral strategies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”

“…Existing studies recognize the critical role played by PCPs as gatekeepers. Meanwhile, approximately 50% of referrals made by PCPs could have been managed in PHC settings [ 25 ]. However, as we mentioned previously, the referral practice is complex, and many clinical and non-clinical factors play a role in it.…”

Atopic dermatitis: A nationwide study on healthcare pathways and patient satisfaction of disease management in France

“…5 In fact, dermatology placements are not frequent in junior doctor rotations, and as such, the bulk of dermatology learning takes place inpractice during the postgraduate term. 6 Therefore, skin disease remains a learning need for PCPs, and it is paramount to ensure that PCPs are able to manage AD within the scope of their practices. For both, MAD and MSAD, the visited dermatologists are mostly those in private practice rather than those in hospitals.…”