Acne is one of the most common reasons to seek dermatologic care in the United States.1 Owing to the geographically maldistributed workforce and the long wait times to see a dermatologist,2,3 patients seek acne care from nondermatologist physicians. The objectives of this study were to determine the distribution of providers treating acne and to identify patient characteristics that predict seeking care from a dermatologist vs a nondermatologist physician.
We compiled provider data from the 2003 through 2005 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases.4 Beginning in 2002, multistage design variables were used to develop new variables, CSTRATM and CPSUM, which are used with analysis software and an ultimate cluster design for estimating variance.5 This study used ultimate cluster models with NAMCS and NHAMCS files for each year, which were combined to create a data set limited to acne visits.
An observation qualified to enter our data set if 1 of the 3 diagnoses listed for the encounter contained International Classification of Diseases, Ninth Revision (ICD-9) code 706.1 (acne). Weighted national estimates for all office visits that included an ICD-9 code 706.1 were applied to calculate for combined NHAMCS and NAMCS data. The combined data set from 2003 through 2005 yielded 6 912 606 weighted counts from which the proportion of acne encounters by dermatologists and nondermatologist physicians was examined. The data were analyzed with Software for the Statistical Analysis of Correlated Data (SUDAAN), version 9 (RTI International, Research Triangle Park, North Carolina), which computes appropriate SEs that account for the ultimate cluster design. To determine patient demographic predictors for seeing a dermatologist vs a nondermatologist physician, we performed univariate analysis of demographic factors and constructed a multivariable regression model controlling for known confounders (Table).
Most patients in this study were female (64.0%) and white (87.9%). During 2003 through 2005, 64.6% of patients sought acne care from a dermatologist, while the remainder (35.4%) sought care from a nondermatologist physician. Among nondermatologist physicians, pediatricians provided most of the acne care (16.0%), followed by family practitioners (12.0%), internists (5.4%), and obstetricians/gynecologists (1%) (Figure). Significant predictors for receiving acne care from a dermatologist were having acne as the primary diagnosis for the encounter (odds ratio [OR], 11.99; 95% confidence interval [CI], 6.51-22.06) and being prescribed isotretinoin (OR, 10.95; 95% CI, 1.92-62.37). In contrast, factors that significantly decreased the odds of seeing a dermatologist included age younger than 18 years (OR, 0.14; 95% CI, 0.08-0.26), Hispanic or Latino ethnicity (OR, 0.34; 95% CI, 0.14-0.85), obtaining medical care in the Midwest (OR, 0.43; 95% CI, 0.21-0.90) or West region of the United States (OR, 0.42; 95% CI, 0.19-0.95), and having Medicaid and/or SCHIP insurance (OR, 0.21; 95% CI, 0.06-0.78).
2003 Through 2005 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS)4 provider distribution for acne care. OB-GYN indicates obstetrics/gynecology.
Nondermatologist physicians, especially pediatricians and family practitioners, appear to play an important role in caring for patients with acne. This study underscores the challenges of dermatology workforce shortage and the importance of providing continuing education to nondermatology specialties that are managing skin diseases. This study also highlights the need for improving access for populations underserved by dermatologists.
Correspondence: Dr Armstrong, Department of Dermatology, University of California Davis Health System, 3301 C St, Ste 1400, Sacramento, CA 95816 (firstname.lastname@example.org).
Author Contribution: All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Author Contributions:Study concept and design: Armstrong and Idriss. Acquisition of data: Armstrong. Analysis and interpretation of data: Armstrong and Bergman. Drafting of the manuscript: Armstrong. Critical revision of the manuscript for important intellectual content: Armstrong, Idriss, and Bergman. Statistical analysis: Armstrong and Bergman. Obtained funding: Armstrong. Administrative, technical, and material support: Armstrong and Idriss. Study supervision: Armstrong.
Financial Disclosure: None reported.
Additional Contributions: Alexa Kimball, MD, and Robert Stern, MD, provided guidance for this project.
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