C González-Cruz1, M Á Descalzo2, S Arias-Santiago3, A Molina-Leyva3, Y Gilaberte4, P Fernández-Crehuet5, H Husein-ElAhmed6, A Viera-Ramírez7, P Fernández-Peñas8, R Taberner9, A Buendía-Eisman10, I García-Doval11, V García-Patos12. 1. Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Barcelona, España. Electronic address: carlos.gonzalez.cruz@hotmail.com. 2. Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, España. 3. Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, España. 4. Servicio de Dermatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España. 5. Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, España. 6. Servicio de Dermatología, Hospital General de Baza, Baza, Granada, España. 7. Servicio de Dermatología, Hospital Santa Catalina, Las Palmas de Gran Canaria, España. 8. Department of Dermatology, Westmead Hospital, The University of Sydney, Sydney, Australia. 9. Servicio de Dermatología, Hospital Son Llàtzer, Palma, España. 10. Facultad de Medicina, Universidad de Granada, Granada, España. 11. Unidad de Investigación, Fundación Piel Sana, Academia Española de Dermatología y Venereología (AEDV), Madrid, España; Servicio de Dermatología, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España. 12. Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Barcelona, España.
Abstract
BACKGROUND AND OBJECTIVE: Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. MATERIAL AND METHODS: We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). CONCLUSIONS: Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.
BACKGROUND AND OBJECTIVE:Skin lesions are a common reason for consulting a primary care physician. Current legislation in Spain states that purely aesthetic skin problems that do not pose a health problem are not to be treated within the National Health Service. The aim of this study was to estimate the proportion of referrals from primary care physicians to dermatologists that were for cystic lesions or benign tumors and could potentially have been avoided. MATERIAL AND METHODS: We consulted cases registered in the DIADERM study dataset, which is representative of dermatology practice in Spain, and collected the main diagnoses given on referring patients from primary care. A referral diagnosis was classified as potentially avoidable if it corresponded to one of the primary care discharge diagnoses listed in a consensus paper of the Andalusian section of the Spanish Academy of Dermatology and Venereology (AEDV). RESULTS: We collected 2171 main reasons for first-visit referrals to dermatologists; 686 of them (31.6%) were for cystic lesions or benign tumors and classified as potentially avoidable. In 478 cases (22%) the patients were discharged on the first visit. The most frequent diagnoses in such cases were seborrheic keratosis (9.3%) and melanocytic nevus (8.6%). CONCLUSIONS: Nearly a third of referrals from primary care to a dermatologist were for cystic lesions and benign tumors and could have been avoided. A clearer understanding of our caseload can be useful for improving planning, training, and health care system management.
Keywords:
Atención Primaria; Benign skin tumors; Derivación; Dermatology Department; Diagnosis; Diagnósticos; España; Primary health care; Public health services; Referral and consultation; Servicios de Dermatología; Sistema público de salud; Spain; Tumores cutáneos benignos