PATIENTS OPINIONS REGARDING DIRECT ACCESS TO DERMATOLOGICAL SPECIALTYCARE

Many factors such as cost have been used by managed care systems to li mit patient access to specialty care, including dermatology. To date, however, patients' opinions regarding these decisions have not been an alyzed. The purpose of the study was to survey patient opinions regard ing the efficacy, costs, and desirability of gatekeeper-mediated versu s direct access to dermatologic specialty care. One hundred fifteen of 150 consecutive patients who were seen in an outpatient dermatology c linic completed an anonymous survey concerning their current visit. Th ey were asked about referral to the dermatologist by other physicians, number of prior physician visits, and efficacy of therapies received. Patients rated their level of satisfaction with generalist versus spe cialist care for their condition and evaluated the importance of direc t access to dermatologic specialty care. Thirty-nine percent of respon dents (42 of 108) were on their first visit to the dermatologist for t heir current condition. One half of respondents (57 of 115) had previo usly seen another physician for this condition. Thirty percent (34 of 115) had been referred to the dermatologist by another physician, most often a family practitioner or internist. Two thirds (38 of 57) of th ose seen by a previous physician had received therapy from that physic ian, but only one third (12 of 35) believed it to have been of any ben efit. Twenty-three percent (11 of 37) claimed to have incurred more th an five visits to the other physician before seeing the dermatologist. Twenty-four percent of patients (12 of 50) were ''very satisfied'' wi th the previous physician's care compared with 89% (100 of 112) with t he dermatologist's care. Only 6% of respondents (7 of 122) believed a generalist could adequately treat their skin disease. Eighty-seven per cent (100 of 115) described direct access to dermatology as being ''ve ry important'' to their health care. The results of this study suggest that many patients may prefer dermatologic specialists over generalis ts as primary caregivers for diseases of the skin. They may favor dire ct access to dermatologic specialty care for its efficacy and for cost and time savings.