A decision-support algorithm modestly reduced acne-related referrals to dermatologists and increased the likelihood of treatment initiation by referring clinicians, according to a prospective cohort study published in JAMA Dermatology.
“Not only were treatments by referring primary care clinicians similar to those selected by dermatologists, the rates of subsequent referral among these patients were low,” David G. Li, MD, MBA, of the department of dermatology at Brigham and Women’s Hospital at Harvard Medical School in Boston, and colleagues wrote.
The researchers designed a point-of-care electronic health record-based algorithm to alert clinicians who refer treatment-naive patients with acne to a dermatologist. The algorithm notified clinicians that the patient was referred to a dermatology department without trialing prescription treatments first. Clinicians could then keep the referral order and not order treatment; keep the referral order and initiate treatment; remove the referral order and not order treatment; or remove the referral order and initiate treatment.
Included in the study were 260 unique referrals to a dermatology department for acne from 33 different sites from March 2017 to March 2018; 188 (72.3%) were referred for acne only, and 72 (27.7%) were referred for acne and a concurrent dermatologic issue.
The algorithm was associated with the referring clinician starting treatment in 51 cases (19.6%), with 16 of those (31.4%) using one of the notification’s premade order sets.
Among the 188 patients referred for only acne, cancellation of the referral occurred in 34 cases (18.1%), and of those, the referring clinician started treatment in 26 cases (76.5%), with 11 cases (42.3%) using the premade order set. In the 154 cases in which the referral was not canceled, the clinician started treatment in 17 cases (11%), with three (17.6%) using the premade order set.
Among the 72 patients referred for acne and another skin issue, cancellation of the referral occurred in one case (1.4%), with the clinician providing treatment with the premade order set. In the 71 cases in which the referral was not canceled, the clinician started treatment in seven cases (9.9%), with one (14.3%) using the premade order set.
Despite the challenges and limited success of the algorithm, the researchers suggested that these findings support and expand upon existing data regarding the primary care clinician’s role in evaluation and treatment of patients with acne.
“We found that real-time notification may be modestly effective in modifying clinician referral and treatment behavior,” they wrote. “Moving forward, further exploration of educational decision support in combination with more comprehensive initiatives may optimize shared care for acne.” – by Erin T. Welsh
Disclosures: Li reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.