The changing face of dermatological practice: 25 years' experience

Area of Science:

• Dermatology
• Public Health
• Healthcare Services Research

Background:

• Periodic assessment of dermatology service workload and referral trends is crucial for effective service planning.
• Understanding changes in referral numbers, types, and generated workload is essential for resource allocation.

Purpose of the Study:

• To quantify outpatient dermatology workload in hospital and private practices.
• To analyze reasons for referrals to secondary care.
• To examine 25-year changes in the diagnostic spectrum of referred dermatological conditions.

Main Methods:

• All outpatient dermatological consultations in southeast Scotland during November 2005 were recorded.
• Data collected included demographics, referral source and reason, diagnoses, investigations, treatments, and disposal.
• Comparisons were made with four previous studies conducted over a 25-year period.

Main Results:

• A total of 2118 new and 2796 review patients were seen; 89% of new referrals originated from primary care.
• Benign tumors (33.4%), malignant tumors (11.6%), eczema (16%), and psoriasis (7.4%) were common new diagnoses.
• Referral rates increased from 12.6/1000 in 1980 to 21/1000 in 2005, with secondary care referrals rising significantly.

Conclusions:

• Attendances for benign and malignant skin tumors have increased sixfold since 1980.
• Eczema and psoriasis constitute one-third of clinic visits.
• The study confirms a substantial and increasing demand for specialist dermatology services from both primary and secondary care.