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 nondermatologists for diagnosis of skin disease. However, it is not clear whether this affects medical outcome.


OBJECTIVE
We tested the hypothesis that nondermatologists would be more likely than dermatologists to prescribe combination products for the treatment of common fungal skin infections.


METHODS
We analyzed office-based physician visits for fungal skin infections recorded in the 1990-1994 National Ambulatory Medical Care Survey.


RESULTS
There were 4.1 million visits for cutaneous fungal disease of which 82% were to nondermatologists. Nondermatologists were more likely to prescribe combination agents (34.1%) than dermatologists (4.8%, p=0.001). If the percentage of combination agents used by nondermatologists was reduced to that of dermatologists, an estimated $24.9 million or $10.3 million would be saved if clotrimazole or ketoconazole, respectively, were the substituted drug for the combination agent clotrimazole/betamethasone dipropionate.


CONCLUSIONS
Nondermatologists are more likely to use a more expensive, less effective regimen than are dermatologists, suggesting that dermatologists are more cost-effective than nondermatologists in the treatment of common fungal skin disorders.
Westwood Squibb Center for Dermatology Research and the Department of Dermatology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina 27157-1071, USA.
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ES
Smith
A B
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Fleischer
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Feldman
D000287:Administration, Topical; D000553:Ambulatory Care; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D003022:Clotrimazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003880:Dermatology; D003881:Dermatomycoses / Q000188:drug therapy*; D004338:Drug Combinations; D016527:Drug Costs; D005194:Family Practice; D005938:Glucocorticoids; D006801:Humans; D007654:Ketoconazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D009819:Office Visits; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D014005:Tinea / Q000188:drug therapy; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D005938:Glucocorticoids; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D003022:Clotrimazole; D007654:Ketoconazole