Koshnick Rebecca L, Lilly Kia K, St Clair Katherine, Finnegan Mary T, Warshaw Erin M
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Mycoses. 2007 Nov;50(6):463-9. doi: 10.1111/j.1439-0507.2007.01422.x.
Before treating onychomycosis, it is important to exclude other conditions such as lichen planus and psoriasis. The purpose of this study was to evaluate physician preferences and uses of diagnostic tests for toenail onychomycosis (TO) by surveying dermatologists (D), podiatrists (P) and family practitioners (FP) in the United States. Surveys were mailed to approximately 1000 randomly sampled physicians from each of the three specialities. The questionnaire consisted of 15 items regarding physician and practice characteristics, number of patients with TO seen and treated, tests used to diagnose TO and reasons for using the tests. Results were analysed using several statistical methods. Response rates were low (D33.7%; P16.6%; FP28.4%). Ds and Ps (75.2%) and FPs (43.4%) reported feeling 'very confident' at diagnosing onychomycosis. KOH was the preferred diagnostic test for all three specialities. More Ds (75.4%) felt 'very confident' interpreting potassium hydroxide (KOH) exams than Ps (24.9%) and FPs (18.5%). Use of KOH exams was statistically associated with confidence interpreting exams (P P = 0.04092; D & FP P < 0.0001). Some FPs (46.6%) and Ps (21.6%) did not obtain a confirmatory diagnostic test prior to the treatment of onychomycosis while 63.6% of Ds 'almost always/always' did. While limited by low-response rate, this study provides pilot information on the diagnostic preferences for TO by American D, P and FP.
在治疗甲癣之前，排除其他病症（如扁平苔藓和银屑病）很重要。本研究的目的是通过对美国皮肤科医生（D）、足病医生（P）和家庭医生（FP）进行调查，评估他们对趾甲甲癣（TO）诊断测试的偏好和使用情况。调查问卷被邮寄给来自这三个专业领域的约1000名随机抽样的医生。问卷包括15个项目，涉及医生和诊所的特征、看过和治疗过的TO患者数量、用于诊断TO的测试以及使用这些测试的原因。使用几种统计方法对结果进行分析。回复率较低（D为33.7%；P为16.6%；FP为28.4%）。皮肤科医生和足病医生（75.2%）以及家庭医生（43.4%）表示在诊断甲癣时“非常有信心”。KOH是所有三个专业领域首选的诊断测试。与足病医生（24.9%）和家庭医生（18.5%）相比，更多的皮肤科医生（75.4%）对解读氢氧化钾（KOH）检查“非常有信心”。KOH检查的使用与解读检查的信心在统计学上相关（P P = 0.04092；皮肤科医生与家庭医生P < 0.0001）。一些家庭医生（46.6%）和足病医生（21.6%）在治疗甲癣之前没有进行确诊诊断测试，而63.6%的皮肤科医生“几乎总是/总是”进行。尽管受到低回复率的限制，但本研究提供了关于美国皮肤科医生、足病医生和家庭医生对TO诊断偏好的初步信息。
