Dermatologists Prescribe More Topical Corticosteroids Than Family Physicians

Dermatologists prescribe substantially larger amounts and similarly potent topical corticosteroids (TCS) at consultation compared with family physicians, according to study findings published in Journal of the American Academy of Dermatology.

Researchers conducted a cross-sectional study and used population-level administrative health data to estimate differences in the amount and potency of TCS prescribed by dermatologists and family physicians in Ontario, Canada.

The analysis included all Ontario Drug Benefit (ODB) recipients from January 1, 2014, to December 31, 2019, who filled at least 1 TCS prescription from a dermatologist at a consultation visit (index prescription, filled within 30 days of the visit) and at least 1 TCS prescription from a family physician within the previous 12 months.

There were 2 primary outcomes: the mean difference in grams of TCS between the index dermatologist prescription and the highest amount prescribed by a family physician in the previous year, and the mean difference in TCS potency between the index dermatology prescription and the highest potency prescribed by a family physician in the previous year based on a 7-category potency classification.

The analysis included 69,335 participants (mean [SD] age, 63.0 [23.0] years; 53.9% women). Eczema (41.6%) was the most common diagnosis at dermatologist consultation. A total of 12,248 individual physicians were included (12,140 family physicians and 288 dermatologists).

Dermatologists prescribed 34% more TCS in grams on average at consultation vs the highest amount filled on a single date from a family physician prescription in the previous year. Dermatologists also prescribed 54% more than the most recent family physician prescription.

At consultation, the mean (SD) amount of TCS prescribed by dermatologists was 112.7 g (110.6), which was greater than the highest amount (84.0 g [75.4]; mean difference [MD], 27.8 g; 95% CI, 22.8-32.7) and the most recent amount (73.1 g [63.1]; MD, 38.4 g; 95% CI, 33.3-43.4), as well as lower than the cumulative amount (196.0 g [356.7]; MD, -90.3 g; 95% CI, -101.9 to -78.7) prescribed by family physicians in the preceding year.

Multivariable analyses showed that the differences in amount were greater for women family physicians (highest amount: β, 4.02; 95% CI, 1.75-6.30; most recent amount: β, 3.02; 95% CI, 0.91-5.12).

A small, but significant difference in mean (SD) potency prescribed by dermatologists and mean highest potency prescribed by family physicians was observed with use of the reverse-coded 7-category potency classification, with 1 being least potent and 7 being super potent (4.7 [1.8] vs 3.9 [1.9]; MD, 0.7; 95% CI, 0.6-0.8) and a 4-category potency classification, with 1 being weak and 4 being very potent (2.9 [0.8] vs 2.7 [0.9]; MD, 0.2; 95% CI, 0.1-0.2). The differences were greater when the prescribing family physician the patient were both women, and a smaller difference occurred when the patient had a noneczema diagnosis, according to multivariable analyses.

The study was limited by the inclusion of only ODB beneficiaries, which may affect the generalizability of the findings. Some participants may have had exacerbations or improvement in their skin condition while awaiting the dermatology consultation visit.

“Further research is needed to determine whether prescribing smaller amounts of TCS in primary care negatively affects treatment outcomes while awaiting dermatologist consultation,” the researchers conclude. “If so, quality improvement initiatives could be developed to improve TCS prescribing practices in primary care and improve patient outcomes.”