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Original Investigation |

Modeling the Effect of Shared Care to Optimize Acne Referrals From Primary Care Clinicians to Dermatologists

Kristina J. Liu, MD1; Rebecca I. Hartman, MD, MPH1; Cara Joyce, PhD2; Arash Mostaghimi, MD, MPA, MPH3
[+] Author Affiliations
1Harvard Combined Dermatology Residency Program, Boston, Massachusetts
2Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
3Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. 2016;152(6):655-660. doi:10.1001/jamadermatol.2016.0183.
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Importance  Access to dermatologists remains a nationwide challenge. Optimizing referrals to a dermatologist may reduce patient wait times.

Objective  To model the effect of algorithm-based acne treatment by primary care clinicians on referral patterns and costs.

Design, Setting, and Participants  Overall, 253 referrals from primary care clinicians to dermatologists for acne from January 2014 through March 2015 were reviewed at Brigham and Women’s Hospital. No-show rate, diagnostic concordance between primary care clinicians and dermatologists, treatment at the time of referral, and treatment by a dermatologist were ascertained, and we modeled 2 treatment algorithms—initiation of topical treatments by primary care clinicians (algorithm A) and initiation of topical treatments and oral antibiotics by primary care clinicians (algorithm B)—to identify the most effective referral patterns and costs.

Main Outcomes and Measures  The primary outcome was the elimination of unnecessary appointments with a dermatologist. Secondary outcomes included reduction in delay to treatment, health care cost savings, and decrease in no-show rate.

Results  Overall, 150 of 253 referred patients were seen and treated by a dermatologist; 127 patients (50.2%) were not on prescription acne treatment at the time of dermatology referral. Model A reduced initial referrals in 72 of 150 cases (48.0%), eliminated referrals in 60 of 150 cases (40%), and reduced average delay-to-treatment by 28.6 days. This resulted in cost savings of $20.28 per patient, reduction of wait time by 5 days per patient, and decreased the no-show rate by 13%. Model B reduced initial referrals in 130 of 150 cases (86.7%), eliminated referrals in 108 of 150 cases (72%), and reduced average delay-to-treatment by 27.9 days. This resulted in cost savings of $35.68 per patient, shortened wait-time by 9 days per patient, and decreased the no-show rate by 24%.

Conclusions and Relevance  Algorithm-based treatment of acne by primary care clinicians may eliminate unnecessary appointments, reduce wait time for treatment, lower costs, and reduce patient no-shows.

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Of 253 eligible patients, 170 were ultimately evaluated by a dermatologist; 151 were confirmed to have active acne and 150 were started on treatment.

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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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