Optimizing the Dermatologic Formulary at a Free Clinic

Free clinics provide care to underserved populations nationwide. The Birmingham Free Clinic offers dermatology care and operates an onsite dispensary. Little is known about specialty care services and medication optimization in the free clinic setting. This study analyzed dermatologic diagnoses and medication distribution patterns to optimize the dermatologic formulary at a free clinic.

A retrospective chart review was performed of dermatology clinic visits between January 2020 and May 2022. The data analysis used descriptive statistics.

Fifty-seven patients received 158 dermatologic diagnoses and were prescribed 216 medications. The five most common diagnoses were dermatitis (24.1%, 38/158), psoriasis (13.9%, 22/158), acne/rosacea (10.1%, 16/158), alopecia (8.9%, 14/158), and superficial bacterial/fungal infections (6.3%, 10/158). The five most frequently prescribed medications were triamcinolone 0.1% cream (13.4%, 29/216), doxycycline 100 mg (10.6%, 23/216), triamcinolone 0.1% ointment (5.6%, 12/216), ketoconazole 2% shampoo (4.6%, 10/216), and hydrocortisone 2.5% cream (3.7%, 8/216). Fifty-two percent of all prescribed medications were provided onsite. Triamcinolone 0.1% ointment and ketoconazole 2% shampoo were usually unavailable onsite.

Eighty-gram tubes of triamcinolone 0.1% ointment were added to the dermatologic formulary, and low-cost alternatives were suggested for ketoconazole 2% shampoo. This study provides a model for formulary optimization in free clinics with specialty care services.