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

Background: Dermatological diseases account for a substantial share of primary-care visits, yet many are referred to secondary or tertiary services. A notable proportion of dermatology outpatient visits may instead be manageable within primary care. We evaluated whether patients assessed at the tertiary level could have been managed in primary care, in order to inform referral optimization. Methods: In this retrospective, cross-sectional study, the records of 400 patients who presented to the dermatology outpatient clinic of a city hospital in Istanbul between May, and July 2025 were analyzed. Each case was independently classified by three multidisciplinary commissions; each commission comprised a dermatologist, a family medicine specialist, and a general practitioner. Each commission produced a single panel-level management decision per case, and inter-commission agreement across the three commissions was assessed with Fleiss' kappa. Results: Of the 400 patients, 58.8% were female and the mean age was 31.0 ± 17.6 years; 27.5% (n = 110) were pediatric (aged 0-18 years). Overall, 51.5% of cases were judged manageable in primary care (27.5% by a family physician directly and 24.0% with teledermatology support); this was 55.5% in pediatric and 50.0% in adult patients. Only 17.8% of patients had consulted a family physician in the 7 days before attendance. The most frequent diagnoses were acne, dermatitis, and superficial fungal infections. Inter-commission agreement was moderate overall (κ = 0.430; p < 0.001) and lower in pediatric (κ = 0.312) than adult (κ = 0.471) cases. Conclusions: A substantial proportion of tertiary dermatology visits could plausibly be managed in primary care. Realizing this potential depends primarily on strengthening primary-care dermatology capacity, with teledermatology serving as one structured, supportive pathway.