A new study published in JAMA Dermatology Journal says that dermatologists have a great role to play in preventing misdiagnosis of cellulitis and overuse of antibiotics. As per the study, primary care, urgent care, hospitalist and emergency physicians often lack proper training to identify cellulitis mimickers, which constitutes a practice gap. Moreover, patients are overdiagnosed as having cellulitis, which will lead to inappropriate use of antibiotics, unnecessary hospitalizations and consequent rise in healthcare costs while treatment of the true inflammatory condition will be delayed. The study notes that dermatologists can offer their expertise in these scenarios, which will improve patient outcomes and lower healthcare costs.
For the study, 29 patients diagnosed as having cellulitis by their primary care provider were found eligible to participate. The principal investigator examined all enrolled patients, but guided the treatment plan only for those who were randomized to the treatment group. The primary care physician diagnosed cellulitis and administered antibiotics in 100% of the control group, whereas the dermatologist diagnosed cellulitis in only 33% of these patients. At the same time, dermatologists diagnosed cellulitis in only 10% of the patients in the treatment group and only 25% received antibiotics. Overall, the study points out the positive impact of dermatologic consultations on correctly diagnosing pseudocellulitis and avoiding the overuse of antibiotics. The authors opine that these findings are consistent with the past studies which showed that around one third of patients diagnosed as having cellulitis do not really have that condition.
According to the study, the following barriers prevent dermatologists from providing expert assistance in the scenarios discussed earlier.
- Emergency departments and urgent care facilities are not often close to the premises of a dermatologist’s office to allow quick expert consultation.
- Lack of an open line of communication between emergency room physicians and dermatologists is another reason. Some dermatologists may be concerned that opening such a line of communication lead to great surge of after-hour calls and same-day appointment requests. Since most dermatologists may be overbooked for weeks in advance, there may not be reserved slots for same day consultations.
Though the study authors found an additional cost associated with these dermatological visits, correct diagnosis and treatment plan can save healthcare costs in the long run. Here are the possible solutions to the practice gap, as suggested by the authors.
- Rather than managing every patient having cellulitis, form a relationship with one or two urgent care physicians in your community and offer them same-day appointments for the presumed cellulite cases.
- Educating colleagues in other specialties, especially urgent care physicians about recognizing and treating cellulitis mimickers including stasis dermatitis, allergic contact and irritant dermatitis, lipodermatosclerosis, asteatotic eczema and lichen simplex chronicus.
- Directing practitioners to continue medical education activities that address cellulitis mimickers.
However, dermatologists can make diagnostic errors if there are mistakes in the patient’s documents which may in turn lead to wrong medication administration. So, it is vital to make sure the clinical documentation is accurate and legible. Instead of relying completely on electronic health records (EHRs), a blended approach that constitutes both transcription and EHR is always good. This is because there is more chance for errors when copy-pasting patient details hastily during same day consultations. Transcribing the dictations and populating accurate data items into appropriate EHR fields via discrete transcription technology can bring more effective patient outcomes.