Harvard Combined Dermatology Residency Program, Boston, Massachusetts.
Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana.
JAMA Dermatol. 2016 Jun 1;152(6):655-60. doi: 10.1001/jamadermatol.2016.0183.
Access to dermatologists remains a nationwide challenge. Optimizing referrals to a dermatologist may reduce patient wait times.
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.
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.
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%.
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.
获得皮肤科医生的诊治仍然是全国性的挑战。优化向皮肤科医生的转诊可能会减少患者的等待时间。
通过初级保健临床医生基于算法的痤疮治疗模式，研究其对转诊模式和成本的影响。
设计、设置和参与者：总体而言，2014 年 1 月至 2015 年 3 月期间，253 名来自初级保健临床医生的痤疮转诊患者在布莱根妇女医院接受了回顾性研究。确定了缺诊率、初级保健临床医生和皮肤科医生之间的诊断一致性、转诊时的治疗方法以及皮肤科医生的治疗方法，并对 2 种治疗算法进行了建模——初级保健临床医生开始使用局部治疗（算法 A）和初级保健临床医生开始使用局部治疗和口服抗生素（算法 B）——以确定最有效的转诊模式和成本。
主要结果是消除皮肤科医生的不必要预约。次要结果包括减少治疗延迟、节省医疗保健成本和降低缺诊率。
总的来说，253 名转诊患者中有 150 名被皮肤科医生看到并接受了治疗；在皮肤科转诊时，127 名患者（50.2%）没有接受处方痤疮治疗。模型 A 在 150 例中的 72 例（48.0%）中减少了初始转诊，在 150 例中的 60 例（40%）中消除了转诊，并将平均治疗延迟减少了 28.6 天。这使得每位患者节省了 20.28 美元，每位患者的等待时间减少了 5 天，缺诊率降低了 13%。模型 B 在 150 例中的 130 例（86.7%）中减少了初始转诊，在 150 例中的 108 例（72%）中消除了转诊，并将平均治疗延迟减少了 27.9 天。这使得每位患者节省了 35.68 美元，每位患者的等待时间减少了 9 天，缺诊率降低了 24%。
初级保健临床医生基于算法的痤疮治疗方法可以消除不必要的预约，减少治疗等待时间，降低成本，并减少患者缺诊率。
