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Original Investigation |

Trends in Sunscreen Recommendation Among US Physicians

Kristie L. Akamine, MD1; Cheryl J. Gustafson, MD1; Scott A. Davis, MA1; Michelle M. Levender, MD1; Steven R. Feldman, MD, PhD1,2
[+] Author Affiliations
1Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
2Departments of Pathology and Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
JAMA Dermatol. 2014;150(1):51-55. doi:10.1001/jamadermatol.2013.4741.
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Importance  Sunscreen is an important part of sun protection to prevent skin cancer but may not be recommended as often as guidelines dictate.

Objective  To evaluate trends in sunscreen recommendation among physicians to determine whether they are following suggested patient-education guidelines regarding sun protection, and to assess data regarding physician sunscreen recommendations to determine the association with patient demographics, physician specialty, and physician diagnosis.

Design, Setting, and Participants  The National Ambulatory Medical Care Survey was queried to identify patient visits to nonfederal outpatient physician offices at US ambulatory care practices (January 1, 1989–December 26, 2010) during which sunscreen was recommended.

Main Outcomes and Measures  Frequency of sunscreen recommendation.

Results  According to the National Ambulatory Medical Care Survey, there were an estimated 18.30 billion patient visits nationwide. Physicians mentioned sunscreen at approximately 12.83 million visits (0.07%). Mention of sunscreen was reported by physicians at 0.9% of patient visits associated with a diagnosis of skin disease. Dermatologists recorded the mention of sunscreen the most (86.4% of all visits associated with sunscreen). However, dermatologists reported mentioning sunscreen at only 1.6% of all dermatology visits. Sunscreen was mentioned most frequently to white patients, particularly those in their eighth decade of life, and least frequently to children. Actinic keratosis was the most common diagnosis associated with sunscreen recommendation.

Conclusions and Relevance  Despite encouragement to provide patient education regarding sunscreen use and sun-protective behaviors, the rate at which physicians are mentioning sunscreen at patient visits is quite low, even for patients with a history of skin cancer. The high incidence and morbidity of skin cancer can be greatly reduced with the implementation of sun-protective behaviors, which patients should be counseled about at outpatient visits.

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Figure.
Trend in Sunscreen Recommendations by All Physicians at Skin Disease Visits: National Ambulatory Medical Care Survey, 1989-2010

The solid line represents the linear regression fit over time (SAS PROC SURVEYREG; SAS Institute Inc), which demonstrates an annual increase of 0.02% (P = .02) in the frequency of sunscreen recommendation among all physicians for patients with skin disease.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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