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Alexa B Kimball - One of the best experts on this subject based on the ideXlab platform.
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Understanding the cost of dermatologic care: A survey study of Dermatology providers, residents, and patients
Journal of The American Academy of Dermatology, 2017Co-Authors: Aaron J. Steen, Alexa B Kimball, Julianne A. Mann, Valerie M. Carlberg, Michael Musty, Eric L. SimpsonAbstract:Background The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. Objective This study sought to measure Dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. Methods Surveys were systematically developed and distributed to 3 study populations: Dermatology providers, residents, and patients. Results Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. Limitations The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. Conclusion Improving Dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.
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the us Dermatology workforce a specialty remains in shortage
Journal of The American Academy of Dermatology, 2008Co-Authors: Alexa B Kimball, Jack S ResneckAbstract:Introduction Since 1999, multiple surveys have documented a stable undersupply of dermatologic services in the United States. Factors contributing to the imbalance include changes in the demographics of the physician workforce, increased demand for services, and a limited number of training positions for new physicians. In response to the demand, there has also been a substantial influx of nonphysician clinicians into Dermatology offices. Methods We sought to follow up the large data set collected by the American Academy of Dermatology in 2002; the survey was repeated in 2005 and 2007. Response rates ranged from 30% to 35% and included more than 1200 respondents each year. Results Few changes were noted in the metrics used to assess the balance of supply and demand in the US Dermatology workforce between 2002 and 2007. Mean wait times for new patient appointments decreased slightly from 36 to 33 days. One third of practices continue to seek additional dermatologists. In 2007, 23% of practices reported employing a physician assistant and 10% a nurse practitioner (up from 15% and 8% in 2002). In 2007, typical dermatologists continued to spend the bulk of their direct patient care time in medical Dermatology (23.9 hours, 63%), followed by surgery (10.2 hours, 27%), and then cosmetic Dermatology (3.8 hours, 10%). A substantial subset of dermatologists (29%) spent half or more of their time in surgical and cosmetic Dermatology combined. Although female dermatologists worked fewer total hours, they spent equal time caring for patients with medical dermatologic conditions, less time in surgical Dermatology, and more time in cosmetic Dermatology. Limitations The survey is potentially subject to inaccurate self-report and response bias. Although the results shed light on patient access and the Dermatology workforce, they do not establish or quantify any impact on patients' health. Conclusions Between 2002 and 2007, despite continued increases in the number of nonphysician clinicians in US Dermatology offices, there were only small changes in the overall metrics commonly used to assess workforce balance. These findings suggest persistent unmet demand, but, given divergent trends of ongoing increases in surgical and cosmetic Dermatology, growth in the use of physician assistants and nurse practitioners, and an aging and expanding US population, the future balance of supply and demand remains difficult to predict. Nevertheless, careful workforce planning and deliberative consideration of the risks and benefits of rapidly emerging changes in the delivery of dermatologic care are essential to ensure access to high-quality care for patients with skin disease.
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us Dermatology residents satisfaction with training and mentoring survey results from the 2005 and 2006 las vegas Dermatology seminars
Archives of Dermatology, 2008Co-Authors: Scott R Freeman, Alexa B Kimball, Riley E Greene, Anatoli Freiman, David A Barzilai, Sigfrid A Muller, Jodi K Duke, Robert P. DellavalleAbstract:Objective To evaluate residents' satisfaction with Dermatology training and mentorship. Design Written survey. Setting The Las Vegas Dermatology Seminar in 2005 and 2006. Participants Graduating Dermatology residents in the United States. Main Outcome Measures Satisfaction with and importance of 26 training components, overall training satisfaction, satisfaction with availability and quality of mentors, and time spent outside the clinics and classroom with mentors. Results Of Dermatology residents attending the 2005 and 2006 seminars, 57 (50%) and 49 (54%), respectively, completed the survey. In 2006, 38 more surveys were received by mail, for a combined total of 144 respondents. In 2005 and 2006, respectively, 44 (77%) and 66 (76%) residents scored training at or above 7 on a 10-point rating scale. Residents were most satisfied with peer teaching, medical Dermatology training, pathology slide sessions, and live patient conferences and least satisfied with business management and dermoscopy training. Discrepancies between perceived importance and satisfaction were greatest for business management, time for independent study, and responsiveness to resident input. Residents spending 30 minutes (the median) or more per month outside of clinics and the classroom with someone they defined as a mentor reported higher training satisfaction (8.0 vs 7.2; P = .02). Resident-perceived program mentor availability ( P = .001 in 2005, P =.002 in 2006) and quality ( P =.002 in 2005, P≤ .001 in 2006) were also associated with increased overall training satisfaction. Conclusions Of 26 training components, residents were most dissatisfied with business management training. Resident training satisfaction was associated with program mentor availability and quality, as well as time spent with mentors.
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challenges facing academic Dermatology survey data on the faculty workforce
Journal of The American Academy of Dermatology, 2006Co-Authors: Jack S Resneck, Emily P Tierney, Alexa B KimballAbstract:Background There is a perception among many academic dermatologists that departments of Dermatology face severe challenges with recruitment and retention of faculty. In an era when evidence points to a shortage of dermatologists and residency graduates have plentiful private practice offers in almost every geographic area, some fear that academic programs will face even steeper challenges attracting and keeping enough dermatologists on staff. Methods To compare the practice patterns of academic dermatologists with those of the Dermatology workforce in other settings, data from the American Academy of Dermatology 2002 Practice Profile Survey were analyzed (1425 respondents, 35% response rate). Results The mean age of academic dermatologists (45.6 years) was younger than that of those in other practice settings (51.9 years solo practice, 49.0 years multispecialty group), and older age cohorts were significantly less likely to be working in academics ( P Limitations Academic dermatologists reflected a relatively small proportion of survey respondents, and may not be representative of the nation's Dermatology faculty (although the percentage of academics in the survey was similar to that in the overall workforce). Possible response biases could also have affected the survey results. Conclusions The survey results identify a number of differences between the practice patterns of academic dermatologists and their colleagues in other settings, and suggest that academic departments of Dermatology may be facing unique workforce challenges.
Tim Peters - One of the best experts on this subject based on the ideXlab platform.
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Evaluation of a general practitioner with special interest service for Dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital Dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest Dermatology service and hospital Dermatology clinic.\n\nPARTICIPANTS: Adults referred to a hospital Dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (Dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median Dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for Dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Robert P. Dellavalle - One of the best experts on this subject based on the ideXlab platform.
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Dermatology on Google.
Dermatology Online Journal, 2018Co-Authors: Mary K Hill, Ravi R Patel, Pratibha Anand, Robert P. DellavalleAbstract:Author(s): Hill, Mary K; Patel, Ravi R; Anand, Pratibha; Dellavalle, Robert P | Abstract: Google+ sets itself apart from other social media platforms through a number of unique features, including search engine optimization services and high user satisfaction. The purpose of this study was to evaluate the presence of dermatological entities on Google+. Searches were conducted to locate any Google+ accounts associated with the most popular Dermatology journals, dermatological patient-centered organizations, and professional Dermatology-related organizations on social media. Additionally, “Dermatology Google+” was searched via Google, and Google+ profiles retrieved in the first page of results were assessed. Four of the five active Google+ profiles identified in the first page of Google search results were run by private Dermatology practices. Only one of the 13 searched journals was active on Google+. Twenty-six of the 34 patient-centered and professional organizations had Google+ accounts, but only seven of these accounts were active in the last year. Therefore, unlike some private practices, the majority of Dermatology journals and organizations have yet to take advantage of the exclusive opportunities offered by Google+ to expand their audiences and bolster their overall online presence.
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Dermatology on Reddit: elucidating trends in dermatologic communications on the world wide web.
Dermatology Online Journal, 2017Co-Authors: Talayesa Buntinx-krieg, Joseph Caravaglio, Renee Domozych, Robert P. DellavalleAbstract:Platforms of social media, including the website Reddit, have become increasingly popular sites for users to communicate medical information. A study investigating Dermatology content on Reddit has not been performed in the current literature. The purpose of this study is to enumerate the Dermatology subreddits, quantify subscribers, and characterize posts to estimate the presence of Dermatology-related content on Reddit. A Reddit search of the fourteen most common skin diseases globally was performed. Additionally, the terms “Dermatology”, and “skin” were searched in order to identify more subreddits relevant to the field. Dermatology-related subreddits that had ≥1000 subscribers were evaluated for content and categorized for analysis. We identified 38 subreddits related to Dermatology with subscriber numbers ranging from 52 to 209,973. For 17 of the 38 subreddits that were further analyzed, most posts fell under the category of “seeking health/cosmetic advice.” Reddit serves as a communication stage for individuals to discuss, engage, and connect on dermatologic topics. Furthermore, the platform offers an opportunity for medical professionals to distribute evidence-based information concerning dermatologic conditions.
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Dermatology on Snapchat
Dermatology Online Journal, 2017Co-Authors: Ravi R Patel, N Kuseh Kalani Yazd, Robert P. DellavalleAbstract:Launched in 2011, Snapchat is one of the newest social media platforms with over 158 million active daily users. This study investigated the presence of Dermatology-related content on Snapchat. We searched for Snapchat accounts for the top ten most popular Dermatology journals, professional dermatological organizations, and Dermatology-related patient advocate groups on social media. None of the above-mentioned entities were found on Snapchat. Plastic surgeons were found to primarily utilize the application, although one prominent dermatologist was also found. It was theorized that the brevity of the “snaps” was a contributing factor for dermatological organizations to not use the application. However, Snapchat in the right practice setting may be useful for dermatologists, not only to educate followers, but also as a marketing tool to Millennials.
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Dermatology in Doximity.
Dermatology Online Journal, 2016Co-Authors: Kurt A. Ashack, Kyle A. Burton, Robert P. DellavalleAbstract:Doximity, currently the largest online social networking service for United States (US) health care professionals and medical students, provides a wide variety of content to a large audience. In fact, its database includes 1,078,305 physicians in the US. It is therefore important to evaluate this content from time to time. Our objective is to analyze both the residency rankings and news content presented in Doximity, with respect to Dermatology. The study compared the residency rankings created by Doximity to another Dermatology residency ranking system that used a different algorithm. In terms of Dermatology content, seven Dermatology-related search terms were entered into the Doximity search query and data was collected on the first 20 “relevant” articles. Our study evaluated a total of 140 articles. The search term “skin cancer” yielded the most articles totaling 6,001. Informative articles were the most common type of article for each content item searched except for “Dermatology”, yielding research articles as the most common content type (70%). The search term “melanoma awareness” had the largest number of shares (19,032). In comparing Dermatology residency rankings on Doximity with another ranking system that accounted for scholarly achievement, there was 50% overlap. In conclusion, it is vital to evaluate content on social media websites that are utilized by US medical students and health care professionals. We hope this information presented provides an up-to-date analysis on the quality of one particular social media platform.
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Impact of a Dermatology wiki website on Dermatology education.
Dermatology Online Journal, 2015Co-Authors: Chante Karimkhani, Lindsay N. Boyers, Lixia Z Ellis, Sylvia L. Brice, David L Chen, Cory A. Dunnick, Robert P. DellavalleAbstract:Background: The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides Dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities.Objective: To assess medical student and resident satisfaction with the dermwiki website.Methods: Fourth-year medical students taking a Dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year Dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website.Results: Medical students rated the Dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into Dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into Dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year Dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website.Conclusions: Overall, addition of the dermwiki website to the Dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of Dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.
Chris Salisbury - One of the best experts on this subject based on the ideXlab platform.
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evaluation of a general practitioner with special interest service for Dermatology randomised controlled trial
BMJ, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Dilek Berker, Alison Noble, T J PetersAbstract:Abstract Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital Dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest Dermatology service and hospital Dermatology clinic. Participants Adults referred to a hospital Dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. Main outcome measures Primary outcomes were disease related quality of life (Dermatology life quality index) and improvement in patients9 perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median Dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. Conclusions The general practitioner with special interest service for Dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
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Evaluation of a general practitioner with special interest service for Dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital Dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest Dermatology service and hospital Dermatology clinic.\n\nPARTICIPANTS: Adults referred to a hospital Dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (Dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median Dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for Dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
Joanna Coast - One of the best experts on this subject based on the ideXlab platform.
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Patient choice: An exploration of primary care Dermatology patients' values and expectations of care
Quality in Primary Care, 2007Co-Authors: Sue Horrocks, Joanna CoastAbstract:Background: Skin complaints are an important cause of ill-health accounting for a large number of general practitioner (GP) consultations and referrals to secondary care. Organisational developments in the UK have led to GPs with a special interest (GPSI) in Dermatology offering outpatient services in a primary care setting; however, an in-depth exploration of the values Dermatology patients attach to aspects of care or the acceptability of variations in secondary care service delivery has not been reported. Aim: To identify and explore the aspects of care Dermatology patients deemed important in making choices about service use. Design: A qualitative study carried out alongside a randomised controlled trial to compare effectiveness of a GPSI Dermatology service with standard consultant-led Dermatology outpatient care. Setting: United Kingdom. Method: Semi-structured interviews with primary care patients referred for routine Dermatology outpatient appointments. Results: Participants referred for routine outpatients appointments had skin conditions which ranged in severity and impact on their quality of life. Those with minor skin complaints expected their GP to be able to provide more treatments at their local surgery. Some participants who had experienced unsuccessful treatment by their GP reported difficulties in obtaining a specialist referral. Variation in perception and relative importance of the constituents of specialist care was highlighted. Primary care-based specialist services are not always accessible to those living outside the immediate vicinity. Conclusion: GPs should be aware of the impaired quality of life experienced by some patients with chronic skin complaints. GPSI services were acceptable to the majority. However, there is likely to be a group of patients with longstanding, though clinically non-urgent, conditions for whom the service will not be acceptable. © 2007 Radcliffe Publishing.
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evaluation of a general practitioner with special interest service for Dermatology randomised controlled trial
BMJ, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Dilek Berker, Alison Noble, T J PetersAbstract:Abstract Objective To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital Dermatology clinic. Design Randomised controlled trial. Setting General practitioner with special interest Dermatology service and hospital Dermatology clinic. Participants Adults referred to a hospital Dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest. Interventions Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care. Main outcome measures Primary outcomes were disease related quality of life (Dermatology life quality index) and improvement in patients9 perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment. Results 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median Dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service. Conclusions The general practitioner with special interest service for Dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
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Evaluation of a general practitioner with special interest service for Dermatology: Randomised controlled trial
British Medical Journal, 2005Co-Authors: Chris Salisbury, Sue Horrocks, Zoe Crosby, Viv Harrison, Joanna Coast, Andrew Noble, Dilek Berker, Tim PetersAbstract:OBJECTIVE: To assess the effectiveness, accessibility, and acceptability of a general practitioner with special interest service for skin problems compared with a hospital Dermatology clinic.\n\nDESIGN: Randomised controlled trial.\n\nSETTING: General practitioner with special interest Dermatology service and hospital Dermatology clinic.\n\nPARTICIPANTS: Adults referred to a hospital Dermatology clinic and assessed by a consultant or the general practitioner with special interest service,. Suitable patients had non-urgent skin problems and had been identified from the referral letter as suitable for management by a general practitioner with special interest.\n\nINTERVENTIONS: Participants were randomised in 2:1 ratio to receive management by a general practitioner with special interest or usual hospital outpatient care.\n\nMAIN OUTCOME MEASURES: Primary outcomes were disease related quality of life (Dermatology life quality index) and improvement in patients' perception of access to services, assessed nine months after randomisation. Secondary outcomes were patient satisfaction, preference for site of care, proportion of failed appointments, and waiting times to first appointment.\n\nRESULTS: 49% of the participants were judged suitable for care by the general practitioner with special interest service. Of 768 patients eligible, 556 (72.4%) were randomised (354 to general practitioner with special interest, 202 to hospital outpatient care). After nine months, 422 (76%) were followed up. No noticeable differences were found between the groups in clinical outcome (median Dermatology life quality index score = 1 both arms, ratio of geometric means 0.99, 95% confidence interval 0.85 to 1.15). The general practitioner with special interest service was more accessible (difference between means on access scale 14, 11 to 19) and waited a mean of 40 (35 to 46) days less. Patients expressed slightly greater satisfaction with consultations with a general practitioner with special interest (difference in mean satisfaction score 4, 1 to 7), and at baseline and after nine months 61% said they preferred care at the service.\n\nCONCLUSIONS: The general practitioner with special interest service for Dermatology was more accessible and preferred by patients than hospital outpatient care, achieving similar clinical outcomes. Trial registration ISRCTN31962758.
