Dermatology in primary care: Prevalence and patient disposition

Background: Cutaneous disease is commonly encountered in primary care. The frequency of patients presenting to primary care physicians with skin disea se and their eventual disposition is not well studied. Objective: The purpose of this study was to determine the prevalence of pat ients seen with skin disease in a primary care setting and the likelihood o f their referral to a dermatologist. The impact the primary care provider h ad on the quality of skin care was also examined. Methods: A retrospective chart review was performed of patients seen during a 2-year period at a general medicine clinic within the University of Miam i and upon referral to a University of Miami dermatology office. Data were obtained on the prevalence of skin disease, dispositions of referral, diagn oses made, and procedures performed. Results: During a 2-year period, 36.5% of patients who presented to their p rimary care physician had at least one skin problem. Of 208 patients with s kin disease, in 58.7% (122/208) it was their chief complaint. A wide range of diagnoses were made by the primary care physician, with a limited number of diagnostic procedures performed. Of the 37.5% of patients referred to a dermatologist, 68% were referred on initial evaluation. Diagnoses made by the primary care physician were concordant with that made by the dermatolog ists 57% of the time. Conclusion: Patients frequently see their primary care physician for skin d isease. A large percentage are referred to dermatologists, often for a biop sy of a suspect lesion, to confirm a suspected diagnosis, or to establish a diagnosis of lesions of unknown origin.