Rahman S Minhaj, Orengo Amanda Rodriguez, Bowden Acacia, Green Clayton B, Pentland Alice P, Richardson Christopher T, De Benedetto Anna, Plovanich Molly, Wolf Julie Ryan
Department of Dermatology, University of Rochester School of Medicine and Dentistry, 40 Celebration Drive, Rochester, NY, 14642, USA.
Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.
Arch Dermatol Res. 2025 Jan 28;317(1):315. doi: 10.1007/s00403-024-03662-1.
Limited urgent access to board-certified dermatologists drives patients to seek dermatologic care at urgent care centers (UCC). UCC are staffed by clinicians with comparatively limited dermatology training, often resulting in lower quality care for acute dermatology conditions. Using a retrospective cohort of 839 referrals, this study investigates health care referral outcomes for patients seeking dermatologic care at UCC. We further surveyed five dermatologists on the appropriateness of UCC referral and UCC treatment plans in a subset of 40 referrals, as well as the feasibility of referral management by dermatology e-consultation (eConsult). Most patients referred by UCC did not complete an in-person dermatology evaluation (56.5%). Of those that completed an in-person dermatology evaluation, only 29.1% of UCC diagnoses were concordant. While our surveyed dermatologists (≥3/5 consensus) determined only 20% of UCC referrals had appropriate treatment plans, they found most referrals (92.5%) could have been managed with an eConsult with only 5.0% requiring an urgent in-person dermatology evaluation. These data reveal several practice gaps in dermatological care delivery in UCC and inefficiencies in the urgent referral process.
患者难以快速获得皮肤科专科医生的服务，促使他们前往紧急护理中心（UCC）寻求皮肤科护理。UCC的工作人员是皮肤科培训相对有限的临床医生，这往往导致对急性皮肤病的护理质量较低。本研究采用839例转诊病例的回顾性队列研究，调查了在UCC寻求皮肤科护理的患者的医疗转诊结果。我们还对5名皮肤科医生进行了调查，询问了在40例转诊病例子集中UCC转诊及UCC治疗计划的合理性，以及通过皮肤科电子会诊（eConsult）进行转诊管理的可行性。UCC转诊的大多数患者未完成面对面的皮肤科评估（56.5%）。在完成面对面皮肤科评估的患者中，UCC的诊断仅有29.1%是一致的。虽然我们调查的皮肤科医生（≥3/5达成共识）确定只有20%的UCC转诊有适当的治疗计划，但他们发现大多数转诊（92.5%）可以通过电子会诊进行管理，只有5.0%需要紧急进行面对面的皮肤科评估。这些数据揭示了UCC皮肤科护理提供方面的几个实践差距以及紧急转诊过程中的低效问题。
