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Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.

Publication ,  Journal Article
Vickery, EL; Seidler, EM; Jones, TE; Veledar, E; Chen, SC
Published in: JAMA Dermatol
November 2014

IMPORTANCE: There is an increasing demand for a limited number of pigmented lesion clinic (PLC) visits at dermatology centers. OBJECTIVE: To determine the proportion of visits to PLCs that are more frequent ("additional screening") than the recommended ("standard") follow-up schedule and to determine if certain patient characteristics correlate with the demand for these visits. DESIGN, SETTING, AND PARTICIPANTS: A retrospective medical chart review of all PLC visits at an academic dermatology center from October 2010 to January 2012. A total of 609 patients associated with 1756 visits were identified. Of these, 25 patients associated with 26 visits were excluded owing to lack of melanoma diagnosis or risk factors, leaving 584 patients and 1730 visits. Diagnoses of these patients included in situ and invasive melanoma, dysplastic nevi, Spitz nevi, atypical nevus syndrome, family history of melanoma only, and other risk factors. The mean (SD) age was 48 (16) years, and 235 (40.2%) of the patients were male. MAIN OUTCOMES AND MEASURES: The proportion of additional screening visits compared with standard visits. Standard visits were defined as occurring at the following frequencies: annually for mildly dysplastic nevi, Spitz nevi, or solely family history of melanoma; biannually for the first year, then annually thereafter for moderately dysplastic nevi or atypical nevus syndrome; biannually for up to 3 years, then annually thereafter for severely dysplastic nevi or melanomas in situ; every 3 months for 2 years, biannually for the following 2 years, then annually thereafter for invasive melanoma. RESULTS: A total of 1400 visits (80.9%) were standard, 257 (14.9%) were for additional screening, and 73 (4.2%) were "problem focused." Thirty percent of patients had at least 1 additional screening visit. The distribution of diagnoses among standard vs additional screening visits differed significantly, with "family history only" and "other risk factors" taking up a larger percentage of standard visits (15.1%) than the percentage of additional screening visits (8.9%), and all other diagnoses being better represented among additional screening visits (P = .04). No particular patient characteristic described those who sought additional screening visits. CONCLUSIONS AND RELEVANCE: A substantial proportion of additional screening PLC visits exist and are desired by all patients with pigmented lesions. We propose alternative clinic models, such as diagnosis-specific, adjunctive fee-for-additional-service, and teledermatology clinics to meet patient needs while creating resources to expand PLC visits.

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Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

November 2014

Volume

150

Issue

11

Start / End Page

1167 / 1172

Location

United States

Related Subject Headings

  • Time Factors
  • Skin Neoplasms
  • Risk Factors
  • Retrospective Studies
  • Office Visits
  • Nevus, Pigmented
  • Nevus, Epithelioid and Spindle Cell
  • Middle Aged
  • Melanoma
  • Mass Screening
 

Citation

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Vickery, E. L., Seidler, E. M., Jones, T. E., Veledar, E., & Chen, S. C. (2014). Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model. JAMA Dermatol, 150(11), 1167–1172. https://doi.org/10.1001/jamadermatol.2014.1065
Vickery, Erin L., Elizabeth M. Seidler, Todd E. Jones, Emir Veledar, and Suephy C. Chen. “Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.JAMA Dermatol 150, no. 11 (November 2014): 1167–72. https://doi.org/10.1001/jamadermatol.2014.1065.
Vickery EL, Seidler EM, Jones TE, Veledar E, Chen SC. Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model. JAMA Dermatol. 2014 Nov;150(11):1167–72.
Vickery, Erin L., et al. “Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model.JAMA Dermatol, vol. 150, no. 11, Nov. 2014, pp. 1167–72. Pubmed, doi:10.1001/jamadermatol.2014.1065.
Vickery EL, Seidler EM, Jones TE, Veledar E, Chen SC. Supply-and-demand discrepancy in academic pigmented lesion clinics: a case for a new health care delivery model. JAMA Dermatol. 2014 Nov;150(11):1167–1172.

Published In

JAMA Dermatol

DOI

EISSN

2168-6084

Publication Date

November 2014

Volume

150

Issue

11

Start / End Page

1167 / 1172

Location

United States

Related Subject Headings

  • Time Factors
  • Skin Neoplasms
  • Risk Factors
  • Retrospective Studies
  • Office Visits
  • Nevus, Pigmented
  • Nevus, Epithelioid and Spindle Cell
  • Middle Aged
  • Melanoma
  • Mass Screening