Academic Dermatology Practice Research Articles

50906 Adverse Event Tracking and Reporting in an Academic Dermatology Practice

50906 Adverse Event Tracking and Reporting in an Academic Dermatology Practice

Frequency of Skin Biopsies for Psoriasis by Race and Ethnicity

This cross-sectional study evaluates the frequency of skin biopsies, as an indicator of diagnostic uncertainty, by race and ethnicity among patients with psoriasis seen in an academic dermatology practice.

Lived Experiences and Fear of Cancer Recurrence Among Survivors of Localized Cutaneous Melanoma

Most of the rapid increase in cutaneous melanoma incidence in the US has been localized disease that is treated surgically and is associated with high survival rates. However, little is known about the psychological well-being of survivors in the US. To explore the lived experiences and fear of cancer recurrence among survivors of localized cutaneous melanoma. This was a qualitative and survey-based study that used semistructured interviews and the Fear of Cancer Recurrence Inventory short form (FCRI-SF) survey tool with participants recruited from an academic dermatology practice affiliated with the University of Texas, Austin. Interviews were completed via telephone or in person from August 2021 to September 2022. Each of the 9 items in the FCRI-SF was rated on a 5-point Likert scale, scored from 0 to 4, with a maximum possible score of 36 points. Data analyses were performed from February 2022 to June 2023. Semistructured interviews were analyzed for themes and subthemes associated with the lived experiences of survivors of cutaneous melanoma. The FCRI-SF scores were tabulated, with scores of 13 or greater identifying potential cases of clinically significant fear of cancer recurrence. In all, 51 participants (mean [SD] age, 49.5 [11.7] years; 34 [67%] female and 17 [33%] male) with a history of localized melanoma (stage 0-IIA) completed the interview and survey. Among them, 17 (33%) had survived a diagnosis of stage 0 melanoma, and the remainder, at least 1 invasive melanoma diagnosis (stage I-IIA). Semistructured interviews revealed several themes: (1) emotions surrounding follow-up appointments, (2) intensity of melanoma surveillance, (3) lifestyle changes regarding sun exposure, and (4) thoughts about life and death. Thirty-eight of 51 participants had an FCRI-SF score above the threshold for clinical fear of cancer recurrence. This qualitative and survey-based study found that despite having an excellent prognosis, some survivors of localized melanoma, even those who had stage 0, have high rates of fear of cancer recurrence and intense survivorship experiences that affect their psychological well-being.

Retrospective chart review of patient socioeconomic status and language preference associated with live video telehealth in a pediatric dermatology practice.

Pediatric teledermatology rapidly expanded with the COVID-19 pandemic, and the impacts of this expansion on patients' access to care have not yet been entirely defined. In this retrospective study of 3027 patients in an academic pediatric dermatology practice, patients who identified as having a primary language other than English were less likely to access pediatric dermatology care during the COVID lockdown. This study did not identify a significant or meaningful difference in age, geography, socioeconomic status, ethnicity, or race between patients who were offeredpediatric dermatology care that was either in-person or via synchronous telehealth. These findings are overall reassuring that there were not major disparities in telehealth utilization during the COVID shelter-in-place mandate, although highlight the need for institutions to ensure systems are in place to enhance telehealth access for patients with non-English primary language.

34706 An exploration in racial disparities in access to biologic treatment for psoriasis: The experience of a single academic dermatology practice

Introduction: Psoriasis affects 7.5 million people in the U.S., with severe subtypes more prevalent in non-Caucasians compared with Caucasians. African Americans are less likely to receive biologics. More specifically, among those with Medicare, African Americans are 70% less likely to receive biologics. Similar findings are seen among Hispanics, who are less likely to receive certain biologics compared with non-Hispanics. Objective: Our primary objective is to assess if there is a disparity in access to biologics for the treatment of psoriasis in African Americans compared with Caucasian and if so, to identify whether the disparity is related to insurance status or a specific biologic. Methods: This retrospective cohort study identified patients with a psoriasis diagnosis from 2016-2020. Patient race/ethnicity, insurance status, and treatment history was collected and evaluated. Results: Of 2245 patients, 81% were Caucasian and 61% were female. Males were more likely to be on a biologic. There was no significant difference between access to biologics and race or between insurance status and biologic access. Caucasians were more likely to receive more than one biologic compared with African Americans. Conclusions: Sample size differences between this study and previous studies may explain the lack of significance in percentage of African Americans and Caucasians on biologics. The percentage of Medicare patients on a biologic is consistent with other studies. Caucasian patients were three times more likely to have received more than one biologic compared with African American patients, possibly related to predominance in this cohort.

27091 Violence in academic dermatology practices across the United States: A cross-sectional survey study

Background: Although health care workers are at high risk of violence, little is known regarding violence experienced by dermatologists.

28181 A retrospective review of continuation and discontinuation rates of biologic therapy during the COVID-19 pandemic in a single academic center dermatology practice

Background: When the COVID-19 pandemic arose, there was considerable fear among prescribers and patients as to the risk for biologic use for cutaneous conditions. Nevertheless, suspending biologics may cause a higher skin disease burden and lack of response when reintroduced.

27640 Disparities in telemedicine access for Spanish-speaking pediatric patients

The COVID-19 pandemic forced dermatology practices to quickly transition to remote care via telemedicine, and with this change came the prospect of worsening health care disparities for vulnerable populations. To explore this possibility among the pediatric population in our urban academic dermatology practice, we retrospectively compared pediatric teledermatology visits scheduled during the pandemic (03/17/2020-07/31/2020, n = 1078) to in-person appointments scheduled in 2019 (03/17/2019-07/31/2019, n = 3442). Differences were analyzed using chi-squared tests. Hispanic and Spanish-speaking patients scheduled significantly fewer appointments during the pandemic compared with 2019 (20% vs 13%, P < .0001 and 9% vs 5%, P < .0001, respectively). Among the telemedicine cohort, Spanish-speaking patients were much less likely than non–Spanish-speaking patients to have an email address documented within the electronic medical record (EMR, 2.2% vs 58.7%, P = .017). An even smaller proportion of Spanish-speaking patients had activated an online patient portal account prior to their telemedicine visit (1.1% vs 63.0%, P < .0001). Hispanic patients are less likely to receive dermatologic care, and telemedicine could amplify this disparity. During the pandemic, much of our department’s communications have occurred through the patient portal. Our findings suggest that electronic connectedness may represent a bottleneck in telemedicine access for Spanish-speaking pediatric dermatology patients. By presenting the experience at our single institution, we wish to spur dialogue within our specialty to understand and address barriers to pediatric dermatology access in the era of telemedicine.

Electrosurgery Use During Post-Mohs Micrographic Surgery Repair and Complication Rates-How Important is a Dry Field?

Electrosurgery is used to achieve hemostasis during surgery. There are no studies exploring the effects of the use or avoidance of electrodessication during Mohs micrographic surgery (MMS) repair. Given the growing concerns for tissue aerosolization, occupational smoke exposure, and spread of infectious diseases, it is important to determine the importance of electrical hemostasis. In this retrospective study, electronic medical records of a single, tertiary, academic dermatology practice were reviewed. All MMS cases that underwent surgical repair from January 1 to December 31, 2019, by 2 dermatologic surgeons (one who used electrodessication during repair and one who did not) were included. Patient demographic data, information regarding the procedures, and complications occurring 90 days after MMS were recorded. One hundred ninety-eight cases of MMS repair used electrodessication, whereas 193 cases did not. There was no significant difference in the demographic makeup, MMS procedure, or 90-day complication rates between the 2 groups. No major adverse events were MMS-related. The use or avoidance of electrodessication during MMS repair was not associated with increased 90-day postoperative complications, suggesting that a greater tolerance of moderate oozing at a surgical site during MMS repair is reasonable to minimize electrosurgical tissue damage and occupational smoke exposure.

Restructuring an academic dermatology practice during the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus 2 is a highly virulent positive‐sense single stranded RNA virus that spreads rapidly via respiratory droplets, causing severe acute respiratory syndromes with significant mortality and morbidity. Currently 210 countries and territories are affected around the world with a reported 2.6 million confirmed cases. The coronavirus disease 2019 pandemic has changed the way patients attend their specialist appointments and receive medical care. While some specialist clinics have closed we have implemented strategies and restructured our academic practice in Australia to minimize the spread of disease while treating patients who need urgent care. We hope to share these strategies in the hope they may be useful to the dermatology community.

Isotretinoin and iPledge Program patient information video: A new modality that improves patient comprehension

Isotretinoin and iPledge Program patient information video: A new modality that improves patient comprehension

Creation and Validation of Classification Criteria for Discoid Lupus Erythematosus

Classification criteria are the standardized definitions that are used to enroll uniform cohorts for research studies. They emphasize high specificity and are distinct from diagnostic criteria. No universally recognized classification criteria currently exist for discoid lupus erythematosus (DLE), which has led to problematic heterogeneity in observational and interventional clinical studies across the field. To create and validate classification criteria for DLE using 12 previously defined candidate criteria items. For this diagnostic study, candidate criteria items were prospectively applied by dermatologists and dermatopathologists at clinical visits of patients with DLE or a condition that could be confused for DLE, termed a DLE mimicker, at academic dermatology practices across the United States, Poland, Japan, and South Korea. Data were collected from December 1, 2017, to February 1, 2019, and analyzed from March 1 to September 19, 2019. Clinical features among these 2 groups were calculated and compared with χ2 or Fisher exact tests. Candidate models were identified using best subsets logistic regression analysis. Improvement tests, fit statistics, and discrimination were considered to choose a final model. Nine sites contributed 215 patients, 15 of whom had missing or incomplete data. The final model for DLE classification criteria includes only clinical variables: atrophic scarring (3 points), location in the conchal bowl (2 points), preference for the head and neck (2 points), dyspigmentation (1 point), follicular hyperkeratosis and/or plugging (1 point), and erythematous to violaceous in color (1 point), with an area under the receiving operating characteristic curve of 0.91 (95% CI, 0.87-0.95). A score of at least 5 points yields a sensitivity of 84.1% and a specificity of 75.9% in the classification of DLE, with increasing scores yielding higher specificity. These findings provide the initial validation of classification criteria for DLE for use in observational and clinical trials.

Fighting COVID-19: Early teledermatology lessons learned

To the Editor: Coronavirus disease 2019 (COVID-19) has exacerbated the unequal access to medical care experienced by historically marginalized patient populations.1 Early data demonstrate that the infection and death rates in predominantly black neighborhoods are 3-fold and 6-fold higher, respectively, than in predominantly white neighborhoods.2 In response to the pandemic, academic and private dermatology practices have both quickly rolled out teledermatology service in an effort to continue access to care.

Patient-initiated online appointment scheduling: Pilot program at an urban academic dermatology practice

Patient-initiated online appointment scheduling: Pilot program at an urban academic dermatology practice

Patient Ability to Interpret Dermatopathology Reports in an Academic Dermatology Practice

Patient Ability to Interpret Dermatopathology Reports in an Academic Dermatology Practice

Impact of medical scribes on dermatology trainee and attending experience

Medical scribe integration into academic dermatology practices results in decreased attending documentation time, improved physician efficiency, and positive patient satisfaction. However, scribes' impact on dermatology education has not been explored. We conducted a cross-sectional survey at the Brigham and Women's Hospital Dermatology Department and its associated residency program assessing trainee and attending perceptions of scribe impact on documentation time, teaching time, and quality of teaching. Thirty-nine surveys (67% of eligible population) were analyzed. The majority of faculty and trainees perceived that scribes decreased documentation time (92% attendings, 88% trainees), increased attendings' direct teaching time (57% attendings, 76% trainees), increased attending availability to answer questions (57% attendings, 68% trainees), and improved overall education (57% attendings, 80% trainees). Trainees generally perceived educational benefits of scribes more strongly than attendings. Trainees and attendings had discordant views regarding number of patients that the trainee sees (29% attendings, 72% trainees, P&lt;0.05) and the amount of supervision provided for procedures (43% attendings, 56% trainees). The positive impact of scribes on dermatology education is consistent with results in other disciplines. Although hospitals typically invest in scribes to increase physician efficiency, this study suggests that scribes can also improve the educational experience.

Association of Patient Satisfaction With Medical Scribe Use in an Academic Dermatology Practice

Association of Patient Satisfaction With Medical Scribe Use in an Academic Dermatology Practice

Efficacy and Safety of Apremilast Monotherapy for Moderate to Severe Psoriasis: Retrospective Study.

Apremilast is a new oral drug for the treatment of moderate to severe plaque psoriasis that reduces inflammation by inhibiting phosphodiesterase 4. Its efficacy and safety data are limited; hence, real-world outcomes are important for elucidating the full spectrum of its adverse events (AEs) and expanding generalizability of clinical trial findings. Assess the efficacy and safety of apremilast monotherapy in real-world practice. A retrospective chart review was conducted in 2 academic dermatology practices. Efficacy was measured as the proportion of patients achieving a ≥75% reduction from baseline Psoriasis Area and Severity Index score (PASI-75) or a Psoriasis Global Assessment (PGA) score of 0 (clear) or 1 (almost clear) at 16 weeks. Safety was measured as the proportion of patients reporting ≥1 AE at 16 weeks. Thirty-four patients were included. 19 patients (55.9%) achieved PASI-75 or PGA 0/1. 23 patients (67.6%) experienced ≥1 AEs. Five patients (14.7%) withdrew treatment prior to week 16 due to AEs. One patient withdrew treatment due to mood lability and depression. Common AEs included headache (32.4%), nausea (20.6%), diarrhoea (14.7%), weight loss (8.8%), and loose stool (8.8%). Apremilast monotherapy had higher efficacy with similar safety outcomes in the real world compared to clinical trials. There were higher proportions of reported headaches compared to clinical trials. This study supports the apremilast monotherapy clinical trial findings, suggesting that it has an acceptable safety profile and significantly reduces the severity of moderate to severe plaque psoriasis. Limitations include the retrospective nature of the study.

Medical Scribes in an Academic Dermatology Practice

This study examines the implementation of a multipractice quality improvement pilot program evaluating medical scribe impact on dermatologist documentation time and physician satisfaction.

Quality improvement initiative to increase biopsy site photography across a large, multisite academic dermatology practice

Quality improvement initiative to increase biopsy site photography across a large, multisite academic dermatology practice