Improving Primary Care of Pediatric Atopic Dermatitis: An Analysis of Referrals and Educational Need

Atopic dermatitis (AD) is the most common pediatric skin condition, yet many referrals to pediatric dermatology centers are for mild cases that are manageable in primary care. This quality improvement study evaluated 909 referrals to British Columbia Children's Hospital (BCCH), assessing the appropriateness of all AD referrals using a draft BCCH Pediatric AD Care Pathway and comparing each referral to subsequent pediatric dermatology consultations in an effort to establish baseline for future efforts to improve the referral pathway and inform educational resources. Among AD referrals, 47.5% did not meet pathway criteria, most commonly due to lack of treatment mentioned (49.5%), use of inadequate topical corticosteroid potency (34.0%), or absence of topical corticosteroid use (11.7%). Notably, over 70% of referring providers submitted only one referral to BCCH, suggesting that point-of-care educational resources outlining management and referral criteria may be more effective than traditional courses in supporting primary care providers, reducing unnecessary referrals, and improving access to pediatric dermatology.