title: Analysis of factors associated with prescription of a potentially inappropriate combination dermatological medication among US outpatient physicians.
abstract: OBJECTIVE
  Despite concern associated with the necessity of an additional fluorinated, high potency topical corticosteroid, the clotrimazole/betamethasone diproprionate combination remains a frequently prescribed topical agent in the US. This research was performed to better understand the physician and patient characteristics associated with the prescription of this combination medication in outpatient settings.
  
  
  METHODS
  Data from the National Ambulatory Medical Care Survey (1990-2000) were used to determine the patient and physician factors associated with a prescription for clotrimazole/betamethasone diproprionate. The most common diagnoses of patients treated with the drug were also determined.
  
  
  RESULTS
  Family medicine physicians were more than twice as likely (OR: 2.28, 95%CI: 1.56, 3.33) and internists were more than 3 times as likely (OR: 3.10, 95%CI: 1.99, 4.84) to prescribe clotrimazole/betamethasone diproprionate compared to pediatricians, the reference category. Dermatologists were less likely to prescribe these medications compared to pediatricians (OR: 0.35, 95%CI: 0.23, 0.54). Prescription for potentially inappropriate indications was detected across all specialties. Prescription rates of the combination medication were higher among patients of non-white race (OR: 1.56, CI: 1.08, 2.26).
  
  
  CONCLUSIONS
  The increased risk of potentially inappropriate prescription of clotrimazole/betamethasone diproprionate by physicians across all specialties and increased probability of medication receipt in racial minorities is of concern, when safer alternatives such as antifungals or anti-inflammatory medications without the side effects of the combination medication are easily available.
authors.affiliation: Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, NC 27104, USA. rbalkris@wfubmc.edu
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Cook
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Shaffer
authors.forename: Felicia B
authors.initials: FB
authors.lastname: Saltzberg
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
authors.forename: Alan B
authors.initials: AB
authors.lastname: Fleischer
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002648:Child; D002675:Child, Preschool; D003022:Clotrimazole / Q000008:administration & dosage; D003879:Dermatologic Agents / Q000008:administration & dosage*; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008508:Medication Errors / Q000639:trends*; D010819:Physician's Role; D011320:Primary Health Care; D013223:Statistics as Topic; D014481:United States / Q000208:ethnology; D014956:Writing
chemical_list: D003879:Dermatologic Agents; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D003022:Clotrimazole