Dermoscopy Use in Primary Care: A Scoping Review

Background: Patients in many countries with new or changing skin lesions will first consult a primary care physician, often called a general practitioner (GP). With the dramatic rise in melanoma incidence over recent decades, dermoscopy offers a tool with an evidence base supporting its use in skin lesion assessment. How GPs use dermoscopy is unclear. Objectives: A scoping literature review was carried out to examine the current state of published evidence about dermoscopy use in primary care. Methods: The methodological steps taken in this review followed those developed by Arksey and O’Malley, as revised by Levac and colleagues. Four electronic databases were searched for evidence published up to January 2018 describing the use of dermoscopy in a generalist primary care setting. Seven articles were identified for analysis. Results: All included articles have been published since 2007. Most were questionnaire studies and revealed that generally a small minority of GPs use dermoscopy, although some jurisdictions such as Australia report greater use. Dermoscopy is generally used only for the assessment of pigmented skin lesions, but is not used consistently. Several perceived barriers to dermoscopy use, including the need for training, have been reported. Conclusions: There is a paucity of data on dermoscopy use among GPs, and diversity in questionnaire items prevents comparison between jurisdictions. Perceived barriers to dermoscopy use require more in-depth exploration, potentially including qualitative data, to evaluate them more fully. Understanding these factors, including how GPs train in dermoscopy, will be crucial in widening dermoscopy use in primary care.

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Training Primary Care Physicians in Dermoscopy for Skin Cancer Detection: a Scoping Review

Journal of Cancer Education ◽

10.1007/s13187-019-01647-7 ◽

2019 ◽

Vol 35 (4) ◽

pp. 643-650 ◽

Cited By ~ 2

Author(s):

Jonathan A. Fee ◽

Finbar P. McGrady ◽

Cliff Rosendahl ◽

Nigel D. Hart

Keyword(s):

Primary Care ◽

Skin Cancer ◽

Cancer Detection ◽

Primary Care Physicians ◽

Training Programs ◽

Meta Analysis ◽

Skin Lesions ◽

Evidence Base ◽

Care Physician ◽

Skin Cancer Detection

AbstractIn many countries, patients with concerning skin lesions will first consult a primary care physician (PCP). Dermoscopy has an evidence base supporting its use in primary care for skin cancer detection, but need for training has been cited as a key barrier to its use. How PCPs train to use dermoscopy is unclear. A scoping literature review was carried out to examine what is known from the published literature about PCP training in dermoscopy. The methodological steps taken in this review followed those described by Arksey and O’Malley, as revised by Levac et al. Four electronic databases were searched for evidence published up to June 2018. Sixteen articles were identified for analysis, all published since 2000. Ten training programs were identified all of which addressed dermoscopy of pigmented skin lesions, among other topics. Ten articles reported on a range of outcomes measured after training and showed generally positive results in terms of improved diagnostic performance, although no meta-analysis was conducted. However, it was unclear whether trained PCPs continued to use dermoscopy after training. Observational questionnaire data revealed that many PCPs use dermoscopy in practice without any formal training. The literature generally supports the use of dermoscopy by PCPs, but it is unclear whether current training leads to long-term change in PCPs’ use of dermoscopy in clinical practice. Understanding this problem, as well as exploring PCPs’ training needs, is essential to develop training programs that will facilitate the uptake and use of dermoscopy in primary care.

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Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study

Journal of Medical Internet Research ◽

10.2196/16700 ◽

2020 ◽

Vol 22 (4) ◽

pp. e16700 ◽

Cited By ~ 2

Author(s):

Mara G Bianchi ◽

Andre Santos ◽

Eduardo Cordioli

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Physician ◽

Primary Care Physicians ◽

Malignant Tumors ◽

Skin Lesions ◽

Care Physician ◽

Pigmentary Disorders ◽

The World ◽

Skin Conditions

Background Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. Objective Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. Methods This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. Results Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. Conclusions Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

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Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study (Preprint)

10.2196/preprints.16700 ◽

2019 ◽

Author(s):

Mara G Bianchi ◽

Andre Santos ◽

Eduardo Cordioli

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Care Physician ◽

Primary Care Physicians ◽

Malignant Tumors ◽

Skin Lesions ◽

Care Physician ◽

Pigmentary Disorders ◽

The World ◽

Skin Conditions

BACKGROUND Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. OBJECTIVE Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. METHODS This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. RESULTS Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. CONCLUSIONS Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

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Medical Issues in Adolescent Substance Use: Background and Role of the Primary Care Physician

The Oxford Handbook of Adolescent Substance Abuse ◽

10.1093/oxfordhb/9780199735662.013.39 ◽

2016 ◽

pp. 574-592

Author(s):

Miriam Schizer ◽

Elissa R. Weitzman ◽

Sharon Levy

Keyword(s):

Primary Care ◽

Substance Use ◽

Specific Treatment ◽

Primary Care Providers ◽

Evidence Base ◽

Care Physician ◽

Care Providers ◽

Adolescent Substance ◽

Medical Issues

Use of psychoactive substances is both common during adolescence and highly associated with acute and chronic health risks. Routine health care provides an opportunity to provide a range of interventions—from primary prevention to assisting adolescents with substance use disorders in accessing treatment. In particular, primary care offers a unique opportunity to intervene with adolescents who have developed substance use problems but do not meet criteria or are unwilling to enter specific treatment for a substance use disorder, and thus provide a level of service for adolescents who would otherwise likely receive no intervention. This chapter reviews the evidence base for primary care interventions and explores the role for primary care providers.

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