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Assessing adherence to evidence-based guidelines of care for acne vulgaris
Spencer Dunaway1, Alan B Fleischer1
1Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Background:
Care guidelines are developed to assist in performing high-quality, cost-effective care.
Objective:
This study was designed to assess the adherence to evidence-based guidelines of care for acne.
Methods:
For acne treatment, we analyzed 2008-2015 National Ambulatory Medical Care Survey visits. For each medication mention, a grade was assigned based upon the American Academy of Dermatology 2007 treatment guidelines.
Results:
Most encounters achieved the grade of A, regardless of specialty or patient population. A proportion of visits involved the use of oral antibiotics monotherapy, which occurred at 11.7% (8.6-14.8) dermatologist and 25.6% (12.4-38.8) of non-dermatologist visits. Although not addressed in the 2007 guidelines, this practice was not recommended in the updated 2016 guidelines.
Limitations:
Other factors influencing prescribing behaviors cannot be completely assessed using extant data.
Conclusion:
This study demonstrates that nearly all physicians adhered to the 2007 guidelines. Many prescribed antibiotic monotherapy a practice not supported by the evidence.Capsule summaryAlthough acne practice guidelines are published, adherence to these guidelines is unknown.Using a grading system analogous to the United States A to F system, virtually all providers receive a grade of A. We expect that the grade will be lower in the future.
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