Smith E S, Fleischer A B, Feldman S R
Westwood Squibb Center for Dermatology Research and the Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1071, USA.
J Am Acad Dermatol. 1998 Jul;39(1):43-7. doi: 10.1016/s0190-9622(98)70400-1.
Dermatologists have greater accuracy than nondermatologists for diagnosis of skin disease. However, it is not clear whether this affects medical outcome.
We tested the hypothesis that nondermatologists would be more likely than dermatologists to prescribe combination products for the treatment of common fungal skin infections.
We analyzed office-based physician visits for fungal skin infections recorded in the 1990-1994 National Ambulatory Medical Care Survey.
There were 4.1 million visits for cutaneous fungal disease of which 82% were to nondermatologists. Nondermatologists were more likely to prescribe combination agents (34.1%) than dermatologists (4.8%, p=0.001). If the percentage of combination agents used by nondermatologists was reduced to that of dermatologists, an estimated $24.9 million or $10.3 million would be saved if clotrimazole or ketoconazole, respectively, were the substituted drug for the combination agent clotrimazole/betamethasone dipropionate.
Nondermatologists are more likely to use a more expensive, less effective regimen than are dermatologists, suggesting that dermatologists are more cost-effective than nondermatologists in the treatment of common fungal skin disorders.
皮肤科医生在诊断皮肤疾病方面比非皮肤科医生更准确。然而，尚不清楚这是否会影响医疗结果。
我们检验了这样一个假设，即非皮肤科医生比皮肤科医生更有可能开具联合用药产品来治疗常见的皮肤真菌感染。
我们分析了1990 - 1994年国家门诊医疗护理调查中记录的因皮肤真菌感染而进行的门诊就诊情况。
有410万次因皮肤真菌病的就诊，其中82%是看非皮肤科医生。非皮肤科医生比皮肤科医生更有可能开具联合用药（34.1%对4.8%，p = 0.001）。如果将非皮肤科医生使用联合用药的比例降至皮肤科医生的水平，若分别用克霉唑或酮康唑替代联合用药产品克霉唑/二丙酸倍他米松，估计可节省2490万美元或1030万美元。
非皮肤科医生比皮肤科医生更有可能使用更昂贵、效果更差的治疗方案，这表明在治疗常见皮肤真菌病方面，皮肤科医生比非皮肤科医生更具成本效益。
