Shared medical appointments (SMAs) are an emerging clinic model designed to address health care access, patient education, and shared decision making issues as well as clinical outcomes and increased health care provider productivity. However, not all SMAs have uniformly demonstrated viability. Key to SMA success is the ability to fill them to optimal census levels. The high prevalence of a number of dermatologic procedures, such as full-body skin examinations and acne evaluations, make these procedures well suited for SMAs. In this cost-benefit analysis, SMAs generated significantly higher census levels and profits than the mean provider census for the individual leading the SMA. These data support a business case for dermatologic SMAs as a means of simultaneously improving access and productivity and the bottom line.
Like many medical specialists, dermatologists are struggling to accommodate a growing demand for appointments due to a critical shortage of physicians, a geographically maldistributed workforce, and a rise in skin cancer prevalence. Most Americans have Internet access, mobile phones, and digital cameras, all of which may be used to support remote, asynchronous communication between patient and physician. In this prospective, randomized controlled study of 151 patients with mild to moderate facial acne, Watson et al demonstrate that follow-up care via a remote e-visit platform produced equivalent clinical outcomes to in-office care. Health care reforms such as a shift from visit-based to outcome-based reimbursement may promote adoption of online health care delivery platforms.
Early diagnosis of nail unit melanoma presents challenges for dermatologists. Longitudinal melanonychia is typically the presenting finding, but this nonspecific finding may also be caused by nail matrix nevi or lentigines. Clinical features that suggest melanoma include inhomogeneous pigmentation, presence of nail plate fissuring, rapid enlargement of the band, triangular shape, blurred borders, and periungual pigmentation. In this survey of 152 dermatologists of varying expertise, Di Chiacchio et al demonstrated low diagnostic accuracy of clinical evaluation, ABCDEF rule application, and nail plate dermoscopy. Intraoperative dermoscopy was the only technique that statistically improved the diagnostic accuracy for each category of dermatologist.
Despite ongoing efforts to educate the public about health risks associated with UV radiation, recreational tanning continues to increase among young adults. Reinforcing properties for UV tanning that have been conceptualized within the addiction framework include the desire for appearance enhancement, relaxation, improved mood, and socialization. In this survey of college students, Mosher and Danoff-Burg demonstrate that among those who used indoor tanning facilities, 39.3% met DSM-IV-TR criteria, and 30.6% met CAGE criteria for addiction to indoor tanning. These findings suggest that interventions to reduce skin cancer risk should address the addictive qualities of indoor tanning.
Despite the success of laser, light, and radiofrequency (RF) treatment of rhytids and laxity, the surgical face-lift remains the gold standard. Evidence-based medicine demands that the validity of a novel treatment is best tested by comparative trial with the gold standard. In this randomized, blinded, quantitative trial, Alexiades-Armenakas et al compared surgical face-lift with a novel, minimally invasive fractional RF system. Using a quantitative measure of laxity, surgical face-lift patients experienced a mean grade improvement of 1.20, while fractional RF patients achieved a 0.44 grade improvement. These data suggest that fractional RF treatment provides an important nonsurgical option for the treatment of photoaging, and they provide a basis for quantifying cosmetic outcomes from novel treatments with valid comparative analysis with the gold standard.
This Month in Archives of Dermatology. Arch Dermatol. 2010;146(4):367. doi:10.1001/archdermatol.2010.56