Resnick S D, Hornung R, Konrad T R
Division of Dermatology, Bassett Healthcare, Cooperstown, NY, USA.
Arch Dermatol. 1996 Sep;132(9):1047-52.
To compare the approaches of generalist physicians and dermatologists in the management of childhood atopic dermatitis (AD), a 6-page questionnaire was developed to assess specific practice characteristics and therapeutic preferences. Surveys were mailed to all board-certified dermatologists in North Carolina (n = 173) and to a sample of pediatricians (n = 200) and family medicine physicians (n = 300) randomly selected from the North Carolina Health Professions Database. There were 307 eligible respondents, defined as those who see children with AD, and 112 ineligible respondents. The response rate of eligible respondents was 62%. The specialty-specific response rates were as follows: 76% for dermatologists, 70% for pediatricians, and 49% for family medicine physicians.
Dermatologists reported seeing the largest number of patients with AD, followed by pediatricians and family medicine physicians. Dermatologists also reported seeing the highest percentage of pediatric patients with moderate or severe AD (59%), followed by pediatricians (27%) and family medicine physicians (19%). Regardless of the severity of the AD, dermatologists consistently indicated a greater preference for more intensive therapy compared with generalists, as demonstrated by their preference for prescribing more potent topical steroids. Also, dermatologists were more likely than pediatricians (22%) and family medicine physicians (8%) to report "frequent use" of oral antibiotics for AD (63%).
These striking interspecialty differences are likely to affect the outcome and cost of care of childhood AD. The data support the argument for conducting further studies of generalists' and dermatologists' approach to childhood AD, correlating therapeutic approaches with clinical outcomes and costs.
为比较全科医生和皮肤科医生在儿童特应性皮炎（AD）管理中的方法，设计了一份6页的问卷，以评估具体的实践特征和治疗偏好。调查问卷被邮寄给北卡罗来纳州所有获得委员会认证的皮肤科医生（n = 173），以及从北卡罗来纳州医疗专业数据库中随机抽取的儿科医生样本（n = 200）和家庭医学医生样本（n = 300）。有307名合格受访者，即那些诊治AD患儿的医生，以及112名不合格受访者。合格受访者的回复率为62%。各专业的回复率如下：皮肤科医生为76%，儿科医生为70%，家庭医学医生为49%。
皮肤科医生报告诊治的AD患者数量最多，其次是儿科医生和家庭医学医生。皮肤科医生还报告称，诊治的中度或重度AD儿科患者比例最高（59%），其次是儿科医生（27%）和家庭医学医生（19%）。无论AD的严重程度如何，与全科医生相比，皮肤科医生始终表示更倾向于采用更强化的治疗方法，这体现在他们更倾向于开具更强效的外用类固醇药物。此外，皮肤科医生报告“经常使用”口服抗生素治疗AD的比例（63%）高于儿科医生（22%）和家庭医学医生（8%）。
这些显著的专业间差异可能会影响儿童AD的护理结果和成本。这些数据支持进一步研究全科医生和皮肤科医生对儿童AD的治疗方法，并将治疗方法与临床结果和成本相关联的观点。
