If primary care providers initiated therapy in patients with mild to moderate acne, they could significantly decrease referrals to dermatologists, reduce patient waiting times, and cut health care costs, based on a study published online March 6 in JAMA Dermatology.
The researchers used retrospective data to model two treatment algorithms for initiating acne therapy based on evaluations of 253 dermatology referrals by primary care physicians at a single center. Half of the acne patients had not received any topical or systemic treatment prior to their referral to a dermatologist.
Two treatment algorithms were modeled for initiating acne therapy: In the first, the primary care physicians initiated topical acne treatments; in the second, they initiated topical treatments and systemic antibiotics.
If primary care physicians initiated topical acne therapy, the first algorithm predicted a 48% reduction in initial referrals to dermatologists, a 40% overall reduction in referrals, a mean 28.6-day reduction in delay to treatment, and an associated cost savings of $20.28 per patient.
Following the second algorithm entirely eliminated referrals for 72% of patients, reduced initial referrals by 86.7%, and reduced the mean delay to treatment by 27.9 days; the cost savings was $35.68 per patient, wrote Dr. Kristina J. Liu of the Harvard Combined Dermatology Residency Program and coauthors (JAMA Dermatol. 2016 March 6. doi: 10.1001/jamadermatol.2016.0183).
“Our findings are extracted from and applicable to patients who already have access to primary care clinicians. While patients can be efficiently treated by presenting directly to a dermatologist, in many health plans, a referral from primary care is a requisite step that precludes this possibility. Furthermore, 235 patients (93%) in our cohort were being managed by their primary care clinicians for other health conditions in addition to acne. Given these other health concerns, the patients in our study would likely access their primary care clinicians regardless of the problem of acne. Thus, the judicious use of primary care resources to manage acne as part of the holistic care of the patient can prove to be a time- and cost-saving strategy,” the authors wrote.
In addition, 32% of the referrals in the study were for acne plus another dermatologic issue, and such patients likely require dermatologic evaluation regardless of primary care clinician-driven acne management, the authors added.
One author declared employment with Walgreens Boots Alliance. No other conflicts of interest were declared.