NONDERMATOLOGISTS ARE MORE LIKELY THAN DERMATOLOGISTS TO PRESCRIBE ANTIFUNGAL CORTICOSTEROID PRODUCTS - AN ANALYSIS OF OFFICE VISITS FOR CUTANEOUS FUNGAL-INFECTIONS, 1990-1994/

Background: Dermatologists have greater accuracy than nondermatologist s for diagnosis of skin disease. However, it is not clear whether this affects medical outcome. Objective: We tested the hypothesis that non dermatologists would be more Likely than dermatologists to prescribe c ombination products for the treatment of common fungal skin infections . Methods: We analyzed office-based physician visits for fungal skin i nfections recorded in the 1990-1994 National Ambulatory Medical Care S urvey. Results: There were 4.1 million visits for cutaneous fungal dis ease of which 82% were to nondermatologists. Nondermatologists were mo re likely to prescribe combination agents (34.1%) than dermatologists (4.8%, p = 0.001). if the percentage of combination agents used by non dermatologists was reduced to that of dermatologists, an estimated $24 .9 million or $10.3 million would be saved if clotrimazole or ketocona zole, respectively, were the substituted-drug for the combination agen t clotrimazole/betamethasone dipropionate. Conclusion: Nondermatologis ts are more likely to use a more expensive, less effective regimen tha n are dermatologists, suggesting that dermatologists are more cost-eff ective than nondermatologists in the treatment of common fungal skin d isorders.