Primary care physicians as gatekeepers in managed care : Primary care physicians'and Dermatologists'skills at secondary prevention of skin cancer.
Background and Design
This study determines (1) the readiness of primary care physicians (PCPs) to triage optimally lesions suspicious for skin cancer, (2) the difference in their abilities from those of dermatologists, and (3) whether accurate diagnosis after viewing slide images transfers to accurate diagnosis after viewing lesions on patients.
Seventy-one primary care residents and 15 dermatologists and resident dermatologists diagnosed and selected a treatment/diagnostic plan for skin lesions suspicious for cancer.
The lesions were shown on slides, computer images, and patients.
Participants'performance was compared with biopsy results of all lesions.
Dermatologists'scores were almost double those of primary care residents, and primary care residents'performance was positively associated with previous experience in dermatology.
Primary care residents failed 50% of the time to diagnose correctly nonmelanoma skin cancer and malignant melanomas, and 33% of the time they failed to recommend biopsies for cancerous lesions.
Primary care residents failed to diagnose malignant melanomas 40% of the time ; dermatologists failed to do so 26% of the time.
Both groups performed better using slide images compared with patients.
Primary care residents may not be ready to assume a gatekeeper role for lesions suspicious for skin cancer. (...)
Mots-clés Pascal : Tumeur maligne, Peau, Diagnostic, Etude comparative, Médecin, Performance, Etats Unis, Amérique du Nord, Amérique, Homme, Peau pathologie
Mots-clés Pascal anglais : Malignant tumor, Skin, Diagnosis, Comparative study, Physician, Performance, United States, North America, America, Human, Skin disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0510918
Code Inist : 002B08A. Création : 13/02/1998.