González-Cruz C, Descalzo M Á, Arias-Santiago S, Molina-Leyva A, Gilaberte Y, Fernández-Crehuet P, Husein-ElAhmed H, Viera-Ramírez A, Fernández-Peñas P, Taberner R, Buendía-Eisman A, García-Doval I, García-Patos V
Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Barcelona, España.
Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, España.
Actas Dermosifiliogr (Engl Ed). 2019 Oct;110(8):659-665. doi: 10.1016/j.ad.2019.02.003. Epub 2019 May 29.
Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided.
We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV).
We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%).
Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.
皮肤病变是患者咨询初级保健医生的常见原因。西班牙现行法律规定，纯粹的美学性皮肤问题若不构成健康问题，则不在国家医疗服务体系内进行治疗。本研究的目的是估计初级保健医生转诊至皮肤科医生处治疗囊性病变或良性肿瘤的比例，这些转诊可能是可以避免的。
我们查阅了DIADERM研究数据集中登记的病例，该数据集代表了西班牙的皮肤科诊疗情况，并收集了初级保健转诊患者的主要诊断信息。如果转诊诊断与西班牙皮肤性病学会安达卢西亚分会（AEDV）共识文件中列出的初级保健出院诊断之一相符，则该转诊诊断被归类为可能可避免的。
我们收集了2171例首次转诊至皮肤科医生的主要原因；其中686例（31.6%）是因囊性病变或良性肿瘤转诊，且被归类为可能可避免的。在478例（22%）患者中，首次就诊时即被诊断出院。此类病例中最常见的诊断是脂溢性角化病（9.3%）和黑素细胞痣（8.6%）。
初级保健转诊至皮肤科医生的病例中，近三分之一是因囊性病变和良性肿瘤，且可能是可以避免的。更清楚地了解我们的病例量有助于改善规划、培训和医疗保健系统管理。
