Use of an educational program and an electronic medical record (EMR) ordering tool has been shown to improve the care of acne among pediatricians, thus decreasing referrals to dermatologists, according to the results of an interventional cohort study conducted in San Diego, California, and published in the Journal of the American Academy of Dermatology.1

There has been a practice gap identified among pediatricians who treat patients with acne when compared with their dermatologist colleagues. The prescribing behaviors of dermatologists and pediatricians differ considerably, with topical retinoids prescribed 46.1% of the time by the former and 12.1% of the time by the latter.2

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The investigators sought to examine whether use of an educational program and an EMR ordering tool would improve the treatment of acne among pediatricians while, at the same time, decreasing patient referrals to dermatologists. A total of 116 pediatricians received a guidelines-based educational program. In addition, an ordering tool was developed that permitted severity-based medication prescriptions with customized patient care plans and educational materials. All physicians were surveyed with respect to their attitudes toward and perceived work burden associated with acne care.

Following training and implementation, pediatricians used the ordering tool a total of 546 times over a 4-month period. Acne-coded visits increased significantly from 1078 to 1269 among pediatricians compared with the prior year (odds ratio 1.18; 95% CI, 1.08-1.28; P <.001). A statistically significant absolute decrease of 26% in the percentage of acne referrals to dermatologists was reported (P =.017). Moreover, pediatricians prescribed significantly more retinoids following implementation of the intervention (P =.003), whereas prescriptions for topical clindamycin decreased.

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Odds of a retinoid being prescribed with EMR tool use were 4.96 higher (95% CI, 3.73-6.57; P <.001). After controlling for confounding factors such as gender and insurance status, the odds were 5.13 (95% CI, 3.83-6.92; P <.001). A decreased burden of acne care was reported among pediatricians, with 75% assessing their work as being minimal to no work.

The investigators concluded that adherence to guidelines on the part of pediatricians who care for patients with acne has the potential to improve treatment provided in the primary care setting, enhance patient satisfaction, and permit greater access to dermatologists and pediatric dermatologists among patients with more severe acne and other conditions. Future research will aim to determine the impact of this combined EMR ordering tool and guidelines-based educational program on acne outcomes among pediatric patients.


  1. Borok J, Udkoff J, Vaida F, et al. Transforming acne care by pediatricians: an interventional cohort study [published online May 9, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.04.055
  2. Yentzer BA, Irby CE, Fleischer AB Jr, Feldman SR. Differences in acne treatment prescribing patterns of pediatricians and dermatologists: an analysis of nationally representative data. Pediatr Dermatol. 2008;25(6):635-639.