Primary Care Physicians as Gatekeepers in Managed Care

Evaluation of an Asynchronous Teleconsultation System for Diagnosis of Skin Cancer and Other Skin Diseases

“…However, a series of studies carried out between 1981 and 1996 indicate that the nondermatologists' rate of recognition of skin lesions was essentially 50%. [10][11][12][13][14][15] This rate is no better than chance BARNARD AND GOLDYNE 382 alone, which is not surprising given that Solomon et al 14 found 98% of 723 family practice physicians had 4 weeks or less of dermatology training before starting practice. This amount of exposure is insufficient for producing adequate clinical acumen for dermatological disease.…”

The Association of Medicare Health Care Delivery Systems With Stage at Diagnosis and Survival for Patients With Melanoma

“…11 This is particularly important given results from previous studies that have consistently indicated that dermatologists are superior to nondermatologists in the diagnosis and management of skin disease, including skin cancer. [12][13][14][15][16] This suggests that the provision for payment of preventive services by Medicare or direct access to dermatologists within managed care systems may improve outcomes.…”

An educational intervention to improve diagnosis and management of suspicious skin lesions

“…5,9 The only study that has shown improved clinical performance in diagnosis and management of specially selected skin lesions was a multi-component intervention including one-to-one feedback on performance; 27 however, that study does not equate with the unselected patients seen by these general practitioners. Practitioners showed better diagnosis for benign lesions than skin cancers when they were evaluated by standardized problem-based case studies with photographs, 6 which is opposite to what occurred in practice in this study.…”