600 Improving treatment of acne vulgaris by primary care pediatricians

Abstract

Acne vulgaris is one of the most common dermatologic disorders and may result in profound negative physical and psychosocial side effects including scarring, low self-esteem, depression and suicidal ideation. This intervention aimed to improve child and adolescent acne care given by primary care pediatricians through intensive education of clinicians and implementation of an electronic medical record (EMR) tool. Pediatricians associated with a tertiarycare children's hospital healthcare system in San Diego (n=116) underwent intensive, casebased education on acne assessment and treatment based on published acne treatment guidelines. An EMR tool was implemented that guided classification of acne severity (mild, moderate, and severe) and generated severity-based care plans consisting of prescriptions, non-prescription therapeutics, and customized educational materials for the patient. Outcomes were assessed in 4 month blocks prior to and after implementation of the intervention, and included number of acne-coded visits, patients referred to pediatric dermatology, and prescribing patterns amongst the participating pediatricians. Data was ascertained via EMRaccessed data collection, and survey of participating physicians. Analysis of data pre- and post-intervention revealed an 18% increase in the number of acne-coded visits by pediatricians (OR=1.18, p <0.001), and a 13% decrease in the number of patients referred to pediatric dermatology (OR=0.54, p <0.001). Prescribing patterns of the pediatricians postintervention reflected improved adherence to practice guidelines with a 13% increase in frequency of topical retinoid prescriptions (OR=1.22, p=0.003) and a 15% decrease in frequency of clindamycin prescriptions (OR=0.59, p<0.001). Notably, practitioners perceived a decreased work burden of treating acne.