S R Feldman1, A B Fleischer. 1. Westwood-Squibb Center for Dermatology Research and the Departments of Dermatology and Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Abstract
BACKGROUND: Nonmelanoma skin cancer and actinic keratoses may be partially preventable by physician counseling. OBJECTIVE: The purpose of this study was to assess the frequency of counseling for skin cancer prevention. METHODS: Data on skin cancer counseling and skin examinations were obtained from representative visits to outpatient physicians in the United States from the 1997 National Ambulatory Medical Care Survey. A limitation of the skin examination data is that the extent of the skin examination was not reported. RESULTS: Skin examinations occurred in 60 million (8.6%) of 703 million office visits, and skin cancer prevention counseling or education occurred in 12 million visits (1.5%). For patients younger than 20 years, such prevention counseling occurred in only 1.0% of 169 million visits. For those patients with a current or previous history of nonmelanoma or melanoma skin cancer or actinic keratosis (high-risk patients) identified by the treating physician, 2.8 million (35%) of 7.9 million patients received such counseling. In high-risk patients, dermatologists provided such counseling at 41% of visits, compared with 24% for general and family practice, 9.3% for otolaryngology, 13% for general surgery, and 7.7% for internal medicine. In such high-risk patients, skin examinations were performed at 78% of dermatology visits, 69% of otolarynogolgy visits, 36% of general surgery visits, and 27% of family physician visits. Capitation did not lead to greater primary preventive practices; skin cancer prevention counseling occurred in 4% of high-risk capitated patients compared with 38% of noncapitated patients. CONCLUSION: Physicians provide skin cancer prevention counseling or education at fewer than half of visits for high-risk patients. High-risk patients are likely to receive skin cancer prevention messages depending on the specialty of physician that they visit in roughly the following scheme: dermatologists>family physicians>all other specialties. Economic restraints within managed care systems may affect their "health maintenance" function.
BACKGROUND:Nonmelanoma skin cancer and actinic keratoses may be partially preventable by physician counseling. OBJECTIVE: The purpose of this study was to assess the frequency of counseling for skin cancer prevention. METHODS: Data on skin cancer counseling and skin examinations were obtained from representative visits to outpatient physicians in the United States from the 1997 National Ambulatory Medical Care Survey. A limitation of the skin examination data is that the extent of the skin examination was not reported. RESULTS: Skin examinations occurred in 60 million (8.6%) of 703 million office visits, and skin cancer prevention counseling or education occurred in 12 million visits (1.5%). For patients younger than 20 years, such prevention counseling occurred in only 1.0% of 169 million visits. For those patients with a current or previous history of nonmelanoma or melanoma skin cancer or actinic keratosis (high-risk patients) identified by the treating physician, 2.8 million (35%) of 7.9 million patients received such counseling. In high-risk patients, dermatologists provided such counseling at 41% of visits, compared with 24% for general and family practice, 9.3% for otolaryngology, 13% for general surgery, and 7.7% for internal medicine. In such high-risk patients, skin examinations were performed at 78% of dermatology visits, 69% of otolarynogolgy visits, 36% of general surgery visits, and 27% of family physician visits. Capitation did not lead to greater primary preventive practices; skin cancer prevention counseling occurred in 4% of high-risk capitated patients compared with 38% of noncapitated patients. CONCLUSION: Physicians provide skin cancer prevention counseling or education at fewer than half of visits for high-risk patients. High-risk patients are likely to receive skin cancer prevention messages depending on the specialty of physician that they visit in roughly the following scheme: dermatologists>family physicians>all other specialties. Economic restraints within managed care systems may affect their "health maintenance" function.
Authors: D Bonucchi; J Piattoni; F Ravera; A M Savazzi; G Cappelli; N Pimpinelli; P A Modesti Journal: Intern Emerg Med Date: 2007-12 Impact factor: 3.397
Authors: Angela J Jiang; Melody J Eide; Gwen L Alexander; Andrea Altschuler; Maryam M Asgari; Alan C Geller; Suzanne W Fletcher; Allan C Halpern; Martin A Weinstock Journal: J Cancer Educ Date: 2017-06 Impact factor: 2.037
Authors: Jacqueline M Goulart; Elizabeth A Quigley; Stephen Dusza; Sarah T Jewell; Gwen Alexander; Maryam M Asgari; Melody J Eide; Suzanne W Fletcher; Alan C Geller; Ashfaq A Marghoob; Martin A Weinstock; Allan C Halpern Journal: J Gen Intern Med Date: 2011-04-07 Impact factor: 5.128