title: Filling in Pediatric Acne Practice Gaps: A Prospective Multicenter Study of Case-Based Education.
abstract: Studies have documented practice gaps in acne management between pediatricians and dermatologists. Evidence-based recommendations for acne management were published by the American Acne and Rosacea Society and the American Academy of Pediatrics in 2013. We assess the impact of a case-based learning intervention on pediatrician knowledge and treatment of acne in accordance with published recommendations.
  
  
  
  Participants were recruited at four conferences for pediatric providers. Knowledge of the recommendations and confidence in utilizing them was assessed. Five case-based questions were presented, with providers choosing acne treatments before, immediately after, and 3 months after a case-based educational presentation. Answer selections consistent with the recommendations were scored as correct, and all responses were evaluated for patterns of medication selection.
  
  
  
  A total of 150 individuals participated, most with over 10 years experience. Knowledge of the recommendations and confidence in prescribing acne therapy was poor. The average preintervention management selections were 70% correct, increasing significantly to 86% 3 months after intervention (p < .01). The most significant improvements were demonstrated in provider's ability to choose regimens for moderate acne consistent with published recommendations, and in recommendation-consistent usage of retinoids and benzoyl peroxide (p < .05). Persisting practice gaps included a reluctance to use topical retinoids in preadolescents and lack of initiating oral combination therapies in patients with severe acne.
  
  
  
  A case-based educational intervention significantly increased providers choosing acne treatments in accordance with evidence-based recommendations in an examination setting. Limitations of the study include an inability to assess actual provider prescribing behavior through this methodology.
authors.affiliation: Departments of Dermatology and Pediatrics, Rady Children's Hospital, San Diego and University of California, San Diego, California; Department of Dermatology, University of California, Davis, California.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Feldstein
authors.affiliation: Departments of Dermatology and Pediatrics, Rady Children's Hospital, San Diego and University of California, San Diego, California.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afshar
authors.affiliation: DermOne, West Conshohocken, Pennsylvania.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Krakowski
authors.affiliation: Departments of Dermatology and Pediatrics, Rady Children's Hospital, San Diego and University of California, San Diego, California. Electronic address: leichenfield@rchsd.org.
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Eichenfield
mesh_terms: D000152:Acne Vulgaris / Q000628:therapy*; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000193:education*; D017410:Practice Guidelines as Topic; D000071836:Professional Practice Gaps; D011446:Prospective Studies; D012176:Retinoids / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D012176:Retinoids
keywords: Acne; Education; Practice gaps; Retinoid