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Original Investigation
March 4, 2020

Evaluation of Point-of-Care Decision Support for Adult Acne Treatment by Primary Care Clinicians

Author Affiliations
  • 1Department of Dermatology, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
  • 2University of California, San Francisco School of Medicine, San Francisco
  • 3Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 4Brigham and Women’s Physicians Organization, Boston, Massachusetts
  • 5Loyola University, Chicago, Illinois
JAMA Dermatol. Published online March 4, 2020. doi:10.1001/jamadermatol.2020.0135
Key Points

Question  What are the downstream outcomes following implementation of a real-time, electronic decision-support tool for the treatment of patients referred for acne?

Findings  This prospective cohort study included 260 patients referred by a primary care clinician for acne. Overall, the algorithm was associated with cancellation of the initial referral in 35 of 260 (13.5%) instances and treatment initiation by the referring clinician in 51 of 260 (19.6%) instances.

Meaning  This decision-support algorithm was associated with modestly reduced rates of acne-related referrals to dermatologists and increased likelihood of treatment initiation by the referring clinician.

Abstract

Importance  Acne is a common reason for referral to dermatologists from primary care clinicians. We previously modeled the impact of algorithm-based acne care in reducing dermatology referrals, missed appointments, and treatment delays.

Objective  To prospectively evaluate the downstream outcomes following a real-time, algorithm-based electronic decision-support tool on the treatment of patients referred for acne.

Design, Setting, and Participants  This prospective cohort study included 260 treatment-naive patients referred to a dermatologist for the chief concern of acne, as well as the referring primary care clinicians, at 33 primary care sites affiliated with Brigham and Women’s Hospital from March 2017 to March 2018.

Interventions  We developed and implemented a decision-support tool into the electronic medical record system at an academic medical center. The algorithm identified patients referred to a dermatologist who had not previously been treated for acne and offered guideline-based recommendations for treatment via a real-time notification.

Main Outcomes and Measures  Treatment modification by referring clinicians.

Results  Of 260 patients referred for acne, 209 (80.4%) were women, 146 (56.1%) were non-Hispanic white, and 236 (90.8%) listed English as the preferred language. Patients had a median (quartile 1-quartile 3) age of 28.8 years (24.4-35.1 years) and 185 of 260 had private insurance (71.1%). In total, the algorithm was associated with cancellation of the initial referral in 35 of 260 (13.5%) instances and treatment initiation by the referring clinician in 51 of 260 (19.6%) instances.

Conclusions and Relevance  This decision-support algorithm was associated with a modest reduction in rates of acne-related referrals to dermatologists, and an increased likelihood of treatment initiation by the referring clinician.

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