title: Skin conditions in primary care: an analysis of referral demand.
abstract: BACKGROUND
  Skin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate.
  
  
  METHODS
  Data were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement.
  
  
  RESULTS
  The most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high.
  
  
  CONCLUSIONS
  According to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions-especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care.
authors.affiliation: Área Sanitaria Sur de Granada, Granada, Spain. Electronic address: naniarenas@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Castillo-Arenas
authors.affiliation: Hospital Santa Ana de Motril, Granada, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Garrido
authors.affiliation: Departamento de Dermatología, Facultad de Medicina, Granada, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Serrano-Ortega
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003880:Dermatology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D012871:Skin Diseases / Q000175:diagnosis*; D055815:Young Adult
keywords: Atención Primaria; Concordancia diagnóstica; Demanda derivada; Dermatology; Dermatología; Diagnostic agreement; Motivos de consulta; Presenting complaint; Primary health care; Referral demand