Guideline-Based Medicine Grading based upon the Guidelines of Care for Ambulatory Atopic Dermatitis Treatment in the United States

Publication date: Available online 2 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Alan B. Fleischer

Abstract

Purpose

This study was designed to assess the adherence to evidence-based guideline of care for atopic dermatitis (AD).

Methods

To characterize AD treatment for United States, ambulatory visits from the 2006 to 2015 National Ambulatory Medical Care Survey were analyzed. For each medication prescription, a grade was assigned based upon the American Academy of Dermatology (AAD) treatment guidelines for topical and systemic medications. A composite grade, analogous to the US academic grading system, from A to F, based upon all visit prescriptions was calculated.

Results

Across specialty groups, prescribing differences were noted. Systemic corticosteroids were more likely to be prescribed by family and general physicians (FPGP) and less likely by pediatricians. Dermatologists were more likely than other specialties to prescribe nonsedating antihistamines, which lack a guideline-base supporting their use. Depending upon modeling of care assumptions, all physician specialty visits earned mean guideline-based grades of B or C in their care of AD patients.

Limitations

The clinical, social, and demographic factors influencing prescribing behavior cannot be completely assessed using extant data.

Conclusions

This preliminary study demonstrates that physicians may benefit from reviewing guidelines of care and there may be an educational gap in the implementation of these guidelines.