Solving the ineffective acne consult

In a research letter accepted for publication on April 11, 2016 but not yet published in the British Journal of Dermatology, U.K. researchers report on their survey of patients, carers and health care staff which reveals that patients may have concerns with acne consultations.  

In the paper, “Ineffective consultations for acne: What is important to patients?” the authors also offer potential solutions for how doctors can make those consultations more effective.

More than a cosmetic nuisance

The big picture of acne is changing; yet there is little research about patients’ experiences related to medical consultations for acne.

The prevalence of acne is increasing. Often seen as a disease of adolescence, acne is becoming more prevalent in adults and is starting earlier. Skin conditions are one of the most frequent reasons for people seeking healthcare advice; yet, there is no conclusive data on patterns of help seeking behavior in acne, according to a collective response to questions from Dermatology Times by authors Fiona Cowdell, R.N., at University of Hull, Hull, UK; Alison Layton, M.D., consultant dermatologist and associate medical director for research and development, at the Harrogate and District NHS Foundation Trust; Nick Levell, M.D., director of dermatology, Norfolk and Norwich University Hospital NHS Foundation Trust; Matthew J Ridd, M.D., consultant senior lecturer in primary health care, University of Bristol; and patient representative Charlotte Jones.

READ SIDEBAR: 14 tips for more effective acne consults

“International estimates suggest that around 17 percent to 40 percent of people with acne consult either a primary care physician or a dermatologist,” they write. “Acne, like many skin disorders, is far more than a ‘cosmetic nuisance’ and emotional manifestations may include anxiety and depression, anger, appearance related distress and suicidal ideation. The impact of these problems may be comparable with that experienced by people with disabling conditions, such as asthma, epilepsy and diabetes.”

The emotional impact of acne, they say, doesn’t always correlate with acne’s apparent severity. There may be discrepancies between physician and patient perceptions of disease severity. And while many people seek treatment, there are indications that a proportion of people do not, instead suffering in silence from the skin disease, according to the authors.

NEXT: Getting answers and key messages for providers

Getting answers

The paper on ineffective consultations resulted from the Acne Priority Setting Partnership (PSP), in which the authors used a structured framework to identify and rank unanswered questions about acne treatment. The more than 2,300 people, including 1,456 acne patients, surveyed answered at least one research question, according to a study the authors published on PSP.

“…we collectively identified …‘Top Ten’ uncertainties that were considered to be important areas for acne research,” according to the authors.

In addition to identifying treatment uncertainties, patients were invited to add free text about their experiences with acne treatment.

“We conducted an analysis of the free text and ineffective consultations were frequently identified as a problem and we therefore analysed this data,” the authors write. “As a group of clinicians and researchers, we were not wholly surprised that not all consultations were deemed by patients to be effective. One result of ineffective consultations is that medication may not be used as intended with resulting poor clinical outcomes, increased health care costs and wasted treatment.”

Key messages for providers

While the researchers say it wasn’t possible to fully differentiate whether patients’ online submission referred to care by dermatologists or primary care providers, the majority of comments related to primary care.

“Broadly the data suggested that patients were concerned about the seemingly ‘random’ approach to acne care in which there appeared to be no rationale for the treatments prescribed and no explanation of how treatments may be escalated if not effective,” they write. “In the UK, patients have to be referred to a consultant dermatologist by a primary care physician. Self-referral is not the norm. Patients reported that referral to a dermatologist was often too late and some thought that this had resulted in more severe scarring. The uncertainty and lack of a clear treatment plan added to participants’ disease-related burden.”

Another important patient insight: They suggested that most primary care physicians are not experts in acne care and most dermatologists are not experts in emotional and psychological issues.

“On the whole, they were more confident in the treatments prescribed by dermatologists,” according to the authors.

Fiona Cowdell, R.N., Alison Layton, M.D., Nick Levell, M.D., Matthew J Ridd, M.D., and patient representative Charlotte Jones report no relevant disclosures.