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Original Investigation
January 27, 2021

Temporal Trends and Clinician Variability in Potassium Monitoring of Healthy Young Women Treated for Acne With Spironolactone

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania, Philadelphia
  • 2Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
  • 3Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Associate Editor, JAMA Dermatology
JAMA Dermatol. 2021;157(3):296-300. doi:10.1001/jamadermatol.2020.5468
Key Points

Question  Has the frequency of potassium level monitoring among healthy young women treated for acne with spironolactone decreased following recent study findings suggesting its low usefulness and updated guideline recommendations for this population?

Findings  In this cohort study, the overall proportion of 108 547 women with potassium level monitoring decreased from 41% in 2008 to 38% in 2018, with a greater decrease observed among women treated by dermatologists (49% to 41%) than by internists (40% to 38%) but an increase (71% to 75%) among women treated by advanced practice clinicians (ie, nurse practitioners and physician assistants).

Meaning  This study finds that potassium level monitoring remains common among young women treated for acne with spironolactone, suggesting a need for future efforts to address this practice gap.

Abstract

Importance  Although recent studies and guideline recommendations indicate that potassium level monitoring is of low usefulness for healthy young women being treated for acne with spironolactone, little is known about whether these recommendations have been implemented in clinical practice.

Objective  To evaluate trends in rates of potassium level monitoring among young women treated for acne with spironolactone and clinician variability in monitoring practices.

Design, Setting, and Participants  This retrospective cohort study was conducted between January 1, 2008, and June 30, 2019, using data from the Optum deidentified Clinformatics Data Mart database. Participants comprised 108 547 healthy female patients aged 12 to 45 years who were treated for acne with spironolactone.

Main Outcome and Measures  The primary outcome was the proportion of women who received a test for baseline potassium level and the proportion of women whose potassium levels were monitored in the first 180 days of being treated for acne with spironolactone. For clinicians who had prescribed at least 5 courses of spironolactone, the percentage of clinicians who ordered baseline potassium testing or monitoring and the percentage of clinicians who always monitored potassium were compared between 2008 and 2015 vs between 2016 and 2018.

Results  For 108 547 women included in this cohort study, the mean (SD) age at the start of treatment was 30.7 (8.6) years, and the mean (SD) course duration was 159 (218) days. Between 2008 and 2018, the percentage of women whose potassium levels were monitored within 180 days of starting spironolactone by all clinicians decreased from 41.4% to 38.5%, with a decrease from 48.9% to 41.0% among dermatologists and from 39.7% to 37.7% among internists but with an increase from 71.4% to 75.4% among advanced practice clinicians (ie, nurse practitioners and physician assistants). The proportion of dermatologists who always monitored potassium decreased from 10.6% between 2008 and 2015 to 4.2% between 2016 and 2018. There was no significant difference in the proportion of internists who always monitored potassium from 2008 to 2015 (15.8%) vs from 2016 to 2018 (17.7%).

Conclusions and Relevance  Despite increasing evidence and guidelines supporting the elimination of potassium monitoring among healthy young women treated for acne with spironolactone, the present study findings suggest that potassium monitoring remains common, with substantial variability in clinician practices. There is a need for future implementation and dissemination research to understand underlying factors for this variation and to develop strategies to address this practice gap.

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