Identification of Dermatological Conditions Manageable in Primary Care: A Multidisciplinary Consensus Analysis

Area of Science:

• Dermatology
• Primary Care Medicine
• Health Services Research

Background:

• Dermatological conditions are a significant reason for primary care visits.
• A notable percentage of dermatology outpatient visits are referred to secondary or tertiary care.
• The study investigates the potential for managing tertiary-level dermatology patients within primary care.

Purpose of the Study:

• To evaluate if patients seen at a tertiary dermatology clinic could have been managed in primary care.
• To inform strategies for optimizing referral pathways in dermatology.
• To assess the feasibility of primary care management for common dermatological conditions.

Main Methods:

• Retrospective analysis of 400 patient records from a tertiary dermatology outpatient clinic.
• Independent classification of cases by three multidisciplinary commissions (dermatologist, family medicine specialist, general practitioner).
• Assessment of inter-commission agreement using Fleiss' kappa.

Main Results:

• 51.5% of cases were deemed manageable in primary care (27.5% directly, 24.0% with teledermatology).
• Manageability rates were 55.5% for pediatric and 50.0% for adult patients.
• Moderate inter-commission agreement (κ = 0.430) was observed, with lower agreement in pediatric cases.

Conclusions:

• A substantial proportion of tertiary dermatology referrals are potentially manageable in primary care.
• Strengthening primary care dermatology capacity is crucial for realizing this potential.
• Teledermatology can serve as a supportive pathway for enhancing primary care dermatology services.