Improving Dermatological Care in Primary Care: Consideration of the Collaborative Care Model

Rapid Communication

Austin J Dermatolog. 2016; 3(2): 1050.

Improving Dermatological Care in Primary Care: Consideration of the Collaborative Care Model

Joslyn S Kirby¹*, Abigail Boduch², Lorraine Rosamilia³ and Jeffrey J Miller¹

¹Department of Dermatology, Penn State Milton S, Hershey Medical Center, Pennsylvania, USA

²Penn State College of Medicine, Hershey, Pennsylvania, USA

³Department of Dermatology, Geisinger Health System, Pennsylvania, USA

*Corresponding author: Joslyn S Kirby, Department of Dermatology, Penn State Milton S, Hershey Medical Center, Hershey, Pennsylvania, USA

Received: January 29, 2016; Accepted: March 30, 2016; Published: April 01, 2016

Abstract

Background: Patient referral to dermatologists has been challenging due to poor access and high demand, despite an increased number of non-physician dermatology providers. In addition, alternative models of patient care such as the accountable care organization are expanding. These models encourage Primary Care Physicians (PCPs) to manage conditions to their maximum capacity and comfort.

Objective: To explore PCPs’ experiences and attitudes with dermatologic care in traditional and alternative healthcare models.

Methods: Qualitative research study comprised of semi-structured interviews, were conducted between June 2014 and March 2015 with PCPs in academic and community practice. Two coders independently performed content analysis using a grounded theory approach.

Results: The findings indicate (1) dermatologic conditions are common in primary care and PCPs value more dermatologic knowledge, (2) better communication would facilitate dermatologic care by PCPs, and (3) they supported collaborative care with cooperative clinics and co-management via teledermatology.

Limitations: Limited sample size and result not yet implemented and studied.

Conclusions: This study describes opportunities to change the methods used to deliver dermatological care in the health care system, especially as population-based models of health care expand.

Keywords: Population health; Collaborative care; Primary care; Dermatology; Access; Alternative care models

Abbreviations

PCMH-Patient-Centered Medical Home; ACO-Accountable Care Organization; PCP-Primary Care Physician

Introduction

Skin conditions affect a substantial portion, 21 to 36%, of patients in primary care practices [1,2]. The pattern of referral to a specialist in departments and disciplines for organ-specific conditions remains mostly unchanged [3,4]. Patient referral to dermatologists has been challenging due to poor access and high demand, despite an increased number of non-physician dermatology providers [5-7]. In addition, Primary Care Physicians (PCPs), who are integral to the function of the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACO) models, demonstrate low diagnostic accuracy for skin conditions compared to dermatologists [8,9]. Alternative models of healthcare delivery are being investigated to improve patient outcomes, reduce errors, and improve efficiency. These models encourage a team-based approach to patient care with collaboration among PCPs and specialists, so PCPs are empowered to manage conditions to their maximum capacity and comfort [10]. Collaborative methods to provide high-quality care for patients with dermatologic conditions, need to be explored including integrating specialists into primary care practices, condition-specific guidelines for PCPs, and systematic monitoring. Thus, the objective of this study was to explore PCPs’ experiences and needs to provide dermatologic care and potential changes toward collaborative health care models. A qualitative method was used to explore the multifaceted, complex phenomenon of health care [11,12].

Materials and Methods

Study participants

Faculty from the Departments of Family and Community Medicine or Internal Medicine at the Hershey Medical Center and Geisinger Medical Center or physicians in the surrounding community, who spoke fluent English were eligible. Participants were recruited using email invitations and network sampling [13]. Eligible PCPs were informed of the study goals and gave verbal consent. This study was approved by the institutional review board of the Penn State College of Medicine.

Interview procedures

Semi-structured interviews were performed using an interview guide, which ensured some similarity of content but also flexibility [13]. Interviews were conducted from June 2014 to March 2015. Each interview lasted 60 to 90 minutes. All interviews were conducted in person by two of three researchers (A.B., J.K., L.R.) and audio recorded then transcribed verbatim. Participants received no compensation.

Each participant was asked about his or her experiences providing dermatologic care for patients, including the approximate number of patients and common dermatologic, and the referral of patients. Each participant was also asked to describe his/her understanding of the PCMH, the role of dermatologists and suggestions to deliver dermatologic care. Participants completed a brief survey after the interview that assessed demographic information.

Analysis

One investigator (J.K.) read the transcript line by line after each interview and identified words, phrases and passages related to the provision of dermatological care, or open coding. These codes were used to inform subsequent interviews. Two investigators (J.K. and A.B.) reviewed the preliminary codes and developed the final analytical codes. The analytical codes were independently applied by two coders (J.K. and A.B.) to all of the transcripts [14]. The Spearman correlation for agreement between the coders was 0.83. Differences in coding were discussed until consensus was reached. Data related to the final codes were thematically examined. Thematic saturation was reached by the tenth interview [13,15].

Results and Discussion

Sixteen PCPs participated in the study (Table 1); 12 trained in family and community medicine and four trained in internal medicine. Ten practiced in an academic health system and six practiced in a community practice. The majority (9/16) of the participants completed their training before 2000 and most had some type of dermatology education during medical school or residency. However, six of the participants did not receive dermatologic training in either medical school or residency. Table 2 shows the major themes, sub-themes and representative quotations.

Citation: Kirby JS, Boduch A, Rosamilia L and Miller JJ. Improving Dermatological Care in Primary Care: Consideration of the Collaborative Care Model. Austin J Dermatolog. 2016; 3(2): 1050. ISSN:2381-9197