Pattern of dermatologic care by family physicians versus dermatologists

Mohammad Abd El-Wahed; Azza A Abd El-Azim; Shaimaa M Ishish

doi:10.4103/1110-2098.163922

ORIGINAL ARTICLE

Year : 2015 | Volume : 28 | Issue : 2 | Page : 583-586

Pattern of dermatologic care by family physicians versus dermatologists

Mohammad Abd El-Wahed¹, Azza A Abd El-Azim², Shaimaa M Ishish MBBCh ³
¹ Department of Dermatology, Andrology and Sexually Transmitted Diseases, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
² Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
³ Department of Family Medicine, Al-Batanoon Family Health Center, Ministry of Health, Al-Batanoon, Egypt

Date of Submission	05-Jun-2014
Date of Acceptance	07-Oct-2014
Date of Web Publication	31-Aug-2015

Correspondence Address:
Shaimaa M Ishish
Department of Family Medicine, Al-Batanoon Family Health Center, El-Batanoon, Shebein El-Kom 32736, Menoufia Governorate
Egypt

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/1110-2098.163922

Abstract

Introduction
Skin diseases are common among the general populations and account for a high percentage of all diseases faced by family physician. Skin diseases represent a significant health problem in developing countries. The aim is to improve the health status of skin of patients attending the family healthcare facilities and empower the role of family physician in dermatological care of their patients versus the specialists.
Patients and methods
The study was carried out on 100 patients from the primary healthcare services (group A) and 100 patients from the Outpatient Clinic of the Dermatological Department of Menoufia University Hospital representing the secondary healthcare services (group B). All patients were interviewed after giving consent. They were subjected to full history taking, dermatological examination, and filling the questionnaires for an assessment of the patient satisfaction, compliance, and rights.
Results
The prevalence of skin diseases seen by family physician was 175, 30% of total patients (552) in outpatient clinic of primary healthcare. Patients who visited family physician for a skin lesion said that their lesions were 'better'. Moreover, patients said that they were satisfied with their care. However, there were difficulties in management of allergic and cancerous lesions by family physician; hence, these cases were referred for dermatologists.
Conclusion
For better healthcare utilization, patients with skin diseases should first visit the primary healthcare sites, where they will be subjected to complete comprehensive examination and treated properly or referred to the dermatologist in complicated cases or in difficult diagnosis and recur again for a well-constructed continuity of care.

Keywords: dermatologic care, family health center, family practice

How to cite this article:
El-Wahed MA, Abd El-Azim AA, Ishish SM. Pattern of dermatologic care by family physicians versus dermatologists . Menoufia Med J 2015;28:583-6

How to cite this URL:
El-Wahed MA, Abd El-Azim AA, Ishish SM. Pattern of dermatologic care by family physicians versus dermatologists . Menoufia Med J [serial online] 2015 [cited 2021 Mar 8];28:583-6. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/583/163922

Introduction

Family practitioners constitute the largest group of primary care physicians and as such are responsible for treating a broad range of conditions. Considering that skin disease is the third most common complaint (15.1/100 encounters) encountered in primary care, family practitioners are responsible for a large number of skin-related healthcare visits ^[1] . Patients visit family physicians for skin conditions that range from athlete's foot to eczema to precancerous lesions. Most skin conditions managed by family physicians improve and most patients are satisfied with the care they receive for their skin lesions. According to a new study, a total of 85% of patients contacted a week after their visit to a family physician for a skin lesion said that their lesions were 'better' ^[2] . However, studies have consistently shown a discrepancy in diagnostic accuracy between primary care physicians (PCPs) and dermatologists when diagnosing malignant and precancerous lesions ^[3] . Dealing with dermatological diseases from family medicine point of view versus dermatological specialists is an area that lacks research activities. Hence, this study was conducted to spot light on this aspect.

This study was conducted to assess the prevalence of various skin diseases managed by family physician in addition to determine the patient satisfaction, as well as diagnostic concordance between family physicians and dermatologists in diagnosing and treating skin lesions.

Patients and methods

A total of 552 patients were seen by family physician in the primary healthcare unit, of which 100 patients were included in group A. The study was a cross-sectional comparative study conducted in time frame of 3 months (from October 2013 to the end of December 2013). Target populations were divided into two groups, each consisting of 100 patients who attended Al-Batanoon (village in Egypt) family health unit representing the primary healthcare services (group A) and the other 100 patients who attended the Outpatient Clinic of the Dermatological Department of Menoufia University Hospital representing the secondary healthcare services (group B). Tools needed for data collection were: (i) informed consent and (ii) predesigned and tested questionnaires for recording the personal and sociodemographic data of the studied group; the degree of recognizing the patient's ideas, expectations, and concerns (IECs); receiving patient education; degree of patient satisfaction; level of patient compliance; adherence to the prescribed medications; prescribing based on evidence-based medicine (EBM); recording the level of respecting the patients' rights; level of implementing a continuity of care; and a follow-up plan among the studied groups.

Thereafter, all patients were subjected to discussion of the study aims and designs for taking formal written consent, full history taking including dermatological examination, and filling the questionnaires (approved by the Egyptian Ministry of Health). The research was appreciated by the ethical committee of Faculty of Medicine, Menoufia University.

Results

The prevalence of dermatological diseases was 175, 30% of total number of patients (552) seen by family physician. A cross-sectional comparative study on 100 patients who attended the primary healthcare unit (group A) and 100 patients who attended the secondary healthcare unit (group B) showed the following [Table 1] [Table 2] [Table 3] [Table 4]:

Table 1 Comparison between the studied groups with respect to exploring the patient ideas, expectations, and concerns and receiving patient education messages during their clinical examination

Click here to view

Table 2 Comparison between the studied groups with respect to the degree of compliance and adherence of the prescribed medications with evidence-based medicine

Click here to view

Table 3 Comparison between the studied groups with respect to respecting the patient rights and the continuity of care

Click here to view

Table 4 Comparison between the studied groups with respect to the degree of patient satisfaction

Click here to view

On comparison between the studied groups with respect to their IECs about their skin diseases, there was a significantly higher percentage of patients who asked about their IECs about their dermatological complaint in group A. In addition, on comparison between the studied groups with respect to receiving any educational messages at the time of their clinical examination, there was a significantly higher percentage of patients who received an educational message at the time of doctor interview among those attending the primary healthcare facility (group A).
On comparison between the studied groups with respect to their level of compliance with their prescribed medications, there was a significantly higher percentage of patients who had a good compliance with their prescribed medications among those attending the primary healthcare facility (group A). On comparison between the studied groups with respect to the level of adherence of the prescribed medications with the EBM, there was a nonsignificant difference between the groups; both of them showed a low percentage of adherence to the EBM.
On comparison between the studied groups with regards to the level of respecting the patient rights, there was a significant difference between both groups, where there were highly recognized patients' rights at the primary healthcare facility. On comparison between the studied groups with respect to the level of continuity of care, there was a significant difference between both groups; the patients at the primary healthcare facility were instructed for the management plan and the follow-up schedule in comparison with the higher one in group B.
On comparison between the studied groups with respect to their level of satisfaction with their clinical examination, there was a significantly higher percentage of patients who were fully satisfied with the utilized healthcare services among those attending the primary healthcare facility (group A).

Discussion

The importance of skin diseases is often overlooked. They are usually not life-threatening disorders. Skin diseases are, however, a significant problem all over the world ^[4] . The study was a cross-sectional comparative study. All patients or their care givers attending the selected sites during the selected 3 days weekly from 10 to 12 a.m. were interviewed after giving written or oral consent in case of illiterate participants. The study showed a significantly higher percentage of patients who asked about their IECs about their dermatological complaint among patients attending the primary healthcare sites. These results agree with those of Emodi and Okafor ^[5] but disagree with those of Mahé et al. ^[6] who found no differences. In our study, high percentage of patients asked about their IECs because the family physicians were trained to take the patient's IECs and perceived its importance in dealing with their patients. The study showed a significantly higher percentage of patients who received an educational message at the time of doctor interview among group A, which agree with the study by Hay et al. ^[7] but disagree with the study by Suzana and Badame ^[8] . In our study, high percentage of patients were educated about their diseases and its management because the family physicians were trained to educate carefully their patients either during the interview or in separate sessions at the end of examinations. In addition, there was availability of human resources such as the trained nurses and building facilities such as the family club and counseling room, which enhanced the family physician to practice the patient education activities. The study showed a significantly higher percentage of patients who had a good compliance with their prescribed medications among group A. These results agree with those of Carapetis et al. ^[9] , who found that 81% of their studied patients attending the family healthcare facility were more compliant with their prescribed medications than those attending a higher healthcare facility. However, these results disagree with those of Bakker et al. ^[10] . The study showed a nonsignificant difference between both groups; both of them showed a low percentage of adherence to the EBM. These results agree with those of Fry et al. ^[11] . In our study, the low percentage of physicians practicing the EBM was due to the lack of time as well as proper training in addition to the deficiency in the national clinical guidelines for family physicians at the primary healthcare level. However, at the secondary healthcare level, the consultants and university staff members depend mainly on their clinical expertise and the opinion of their colleagues. The study showed a significant difference between both groups, where there were highly recognized patients' rights at the primary healthcare facility in comparison with the higher one. These results disagree with those of Osendarp et al. ^[12] who found no differences between both groups either those attending the primary or the secondary healthcare systems regarding the level of respecting the patient rights, which was attributed to implementation of the quality assurance system at most of the healthcare facilities. In our study, the high percentage of physicians respecting the patients' rights was because, in family practice, the healthcare is patient centered not disease centered, in which the family physician deals with their patient from the biopsychosocial and spiritual approach, what is called the holistic approach putting in his mind all the patients' rights. The study showed a significant difference between both groups with respect to the instruction for the management plan and the follow-up schedule in comparison with the higher one. These results agree with those of Sandouze et al. ^[13] , which was attributed to implementation of a complete comprehensive care and a quality assurance system at most of the healthcare facilities. In our study, the high percentage of physicians respecting the patients consent before the clinical examination or any manipulative procedures was because, in family practice, the physicians are well trained to take the patients consent before any dealing with them. The study showed a significantly higher percentage of patients who were fully satisfied with the utilized healthcare services among group A.

Conclusion

The patients should first visit the primary healthcare sites, where they are subjected to complete comprehensive examination and treated properly or referred to the dermatologist and recur again for a well-constructed continuity of care.

Recommendations

Proper qualification, support, and continuous medical education of family physicians are needed for management of different dermatological lesions making them up-to-date. Encouragement of a communication link between the family physician in primary healthcare facilities and specialists in secondary healthcare level is required for proper referral system. Special attention should be given to the dermatological diseases in the postgraduate curricula of family medicine teaching. Limitations and obstacles of study included illiteracy of some participants. The researcher dealt with this problem by explaining the purpose of the research to every patient and assuring him that his data will be confidential.

Acknowledgements

Conflicts of interest

There are no conflicts of interest.

References

1.	Estrada Castanon R, Andersson N, Hay R. Community dermatology and the management of skin diseases in developing countries. Trop Doct 1992; 22 :3-6.
2.	Bechelli LM, Haddad N, Pimenta WP, Pagnano PM, Melchior E Jr, Fregnan RC, et al. Epidemiological survey of skin diseases in schoolchildren living in the Purus Valley (Acre State, Amazonia, Brazil). Dermatologica 1981; 163 :78-93.
3.	Porter MJ, Mack RW, Chaudhary MA. Pediatric skin disease in Pakistan. A study of three Punjab villages. Int J Dermatol 1984; 23 :613-616.
4.	Mahé A, Prual A, Konaté M, Bobin P. Skin diseases of children in Mali: a public health problem. Trans R Soc Trop Med Hyg 1995; 89 :467-470.
5.	Emodi IJ, Okafor GO. Clinical manifestations of HIV infection in children at Enugu, Nigeria. J Trop Pediatr 1998; 44 :73-76.
6.	Mahé A, N'Diaye HT, Bobin P. The proportion of medical consultations motivated by skin diseases in the health centers of Bamako (Republic of Mali). Int J Dermatol 1997; 36 :185-186.
7.	Hay RJ, Estrada Castanon R, Alarcon Hernandez H, Chavez Lopez G, Lopez Fuentes LF, Paredes Solis S, Andersson N. Wastage of family income on skin disease in Mexico. BMJ 1994; 309 :848.
8.	Suzana JR, Badame AJ. Incidence of skin diseases in rural Jamaica. Int J Dermatol 2012; 27 :109-111.
9.	Carapetis JR, Connors C, Yarmirr D, Krause V, Currie BJ. Success of a scabies control program in an Australian aboriginal community. Pediatr Infect Dis J 1997; 16 :494-499.
10.	Bakker P, Van Doorne H, Gooskens V, Wieringa NF. Activity of gentian violet and brilliant green against some microorganisms associated with skin infections. Int J Dermatol 1992; 31 :210-213.
11.	Fry AM, Jha HC, Lietman TM, Chaudhary JS, Bhatta RC, Elliott J, et al. Adverse and beneficial secondary effects of mass treatment with azithromycin to eliminate blindness due to trachoma in Nepal. Clin Infect Dis 2002; 35 :395-402.
12.	Osendarp SJ, van Raaij JM, Darmstadt GL, Baqui AH, Hautvast JG, Fuchs GJ. Zinc supplementation during pregnancy and effects on growth and morbidity in low birthweight infants: a randomised placebo controlled trial. Lancet 2001; 357 :1080-1085.
13.	Sandouze GJA, Johnstone PW. Interventions for treating scabies. Cochrane Database Syst Rev 2000;:CD000320.