Assessment of Topical Corticosteroid Prescribing, Counseling, and Communication Among Dermatologists and Pharmacists.

Importance: Topical corticosteroids (TCs) are common treatments for many dermatologic conditions. Anecdotal experience and literature suggest that dermatologists and pharmacists differ in their beliefs about TCs and approach to TC counseling, creating the opportunity for patient confusion. Objective: To examine interprofessional practice gaps between dermatologists and pharmacists with regard to how each group views TCs, counsels patients on TC use, and communicates modifications to TC prescriptions. Design, Setting, and Participants: An electronic survey was disseminated statewide in Wisconsin to 117 board-certified or eligible dermatologist members of the Wisconsin Dermatological Society and 2954 licensed pharmacists. The survey was performed from October 11, 2017, to January 2, 2018. Survey responses and demographic information were compiled and analyzed for each population. Exposures: Study participants completed and returned a 17-question survey recalling experiences with TC prescribing from the past year along with self-reported demographic information. Main Outcomes and Measures: Dermatologists' and pharmacists' self-reported counseling of patients regarding TC application, duration of use, and adverse effects; frequency of communication of changes to TC prescriptions and instructions; and demographic data were tabulated and compared.
Results: Of the 117 dermatologists, 52 (44.4%) completed and returned the survey; of the 2954 pharmacists, 111 (3.8%) returned the survey. Those no longer in active practice (3 dermatologists, 1 pharmacist) were excluded from analysis. A substantial proportion of pharmacists (51 [46.4%]) advised patients to limit TC use to 2 weeks or less, which was an uncommon strategy among dermatologists (3 [6.1%]) (P < .001). Discordance also was noted in the adverse effects that are emphasized in counseling, pharmacist-perceived and dermatologist-observed adverse effects in patients, and resources that inform counseling content. Only 8 (16.3%) dermatologists perceived that pharmacists made no unauthorized modifications to their TC prescriptions or instructions; however, 77 (70.0%) pharmacists reported not doing so (P < .001). Conclusions and Relevance: An interprofessional practice gap appears to exist between dermatologists and pharmacists in Wisconsin regarding TC beliefs and counseling strategies. Collaborative education and improved communication between the 2 groups may be necessary to ensure that patients receive a unified, clear message about TC application and adverse effects. Larger studies are needed to further investigate this potential practice gap.