Skin Diseases in Family Medicine: Prevalence and Health Care Use

Elisabeth W. M. Verhoeven; Floor W. Kraaimaat; Chris van Weel; Peter C. M. van de Kerkhof; Piet Duller; Pieter G. M. van der Valk; Henk J. M. van den Hoogen; J. Hans J. Bor; Henk J. Schers; Andrea W. M. Evers

doi:10.1370/afm.861

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RE: Review on article Skin Diseases in Family Medicine: Prevalence and Health Care Use
Jaisingh Rajput and Prajakta Rajput

Published on: 30 December 2023
Prevalence of skin diseases in family medicine
Andrea W.M. Evers

Published on: 09 August 2010
Prevalence underestimated
Johannes C van der Wouden

Published on: 04 August 2010
The role of patient satisfaction and adherence in skin diseases
Andrea W.M. Evers

Published on: 03 December 2009
Chronic skin diseases and patient involvement in health care
Cristina Renzi

Published on: 03 November 2009

Published on: (30 December 2023)
Page navigation anchor for RE: Review on article Skin Diseases in Family Medicine: Prevalence and Health Care Use
RE: Review on article Skin Diseases in Family Medicine: Prevalence and Health Care Use
Jaisingh Rajput, Family Medicine physician MD, ABFM
Other Contributors:
Prajakta Rajput, Family Physician MD.
1. Sampling Bias:The study relies on a morbidity registry within a network of family practices in the Netherlands, which may introduce sampling bias. The findings may not be representative of the broader population, limiting the generalizability of the results.

2. Response Rate: The article mentions a response rate of 68.0% for the patient questionnaires. While this is relatively good, the non-response of 32.0% could introduce selection bias and affect the accuracy of prevalence estimates, especially if those who did not respond differ systematically from those who did.

3. Self-Reporting:The study utilizes self-reported data for disease-related quality of life, extent, and duration of skin disease. Self-reporting can be subjective and may introduce inaccuracies due to individual interpretation and perception, potentially affecting the reliability of the conclusions.

4. Limited Geographic Scope: The study focuses on family practices in the Netherlands, and cultural, demographic, or healthcare system differences may influence the prevalence and healthcare utilization patterns for skin diseases. This limits the external validity of the findings to other regions or populations.

5. Incomplete Analysis of Alternative Health Care: While the study mentions the utilization of alternative health care practitioners, the analysis of this aspect appears brief. More in-depth exploration and discussion of alternative healthcare practices and their impact on th...
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1. Sampling Bias:The study relies on a morbidity registry within a network of family practices in the Netherlands, which may introduce sampling bias. The findings may not be representative of the broader population, limiting the generalizability of the results.

2. Response Rate: The article mentions a response rate of 68.0% for the patient questionnaires. While this is relatively good, the non-response of 32.0% could introduce selection bias and affect the accuracy of prevalence estimates, especially if those who did not respond differ systematically from those who did.

3. Self-Reporting:The study utilizes self-reported data for disease-related quality of life, extent, and duration of skin disease. Self-reporting can be subjective and may introduce inaccuracies due to individual interpretation and perception, potentially affecting the reliability of the conclusions.

4. Limited Geographic Scope: The study focuses on family practices in the Netherlands, and cultural, demographic, or healthcare system differences may influence the prevalence and healthcare utilization patterns for skin diseases. This limits the external validity of the findings to other regions or populations.

5. Incomplete Analysis of Alternative Health Care: While the study mentions the utilization of alternative health care practitioners, the analysis of this aspect appears brief. More in-depth exploration and discussion of alternative healthcare practices and their impact on the overall management of skin diseases could enhance the comprehensiveness of the study.

6. Lack of Longitudinal Data:The study provides a snapshot of prevalence and healthcare use within a specific timeframe but lacks longitudinal data. Long-term trends and changes in patient behavior over time could provide a more nuanced understanding of the dynamics of skin disease management.

7. Generalization of Family Physician Involvement:While the conclusion suggests that most patients have their skin diseases treated mainly by their family physician, the study does not delve into the specific nature of treatments provided or consider the qualifications and expertise of family physicians in dermatological care.

8. Limited Exploration of Socioeconomic Factors: The article lacks a thorough exploration of socioeconomic factors that might influence healthcare utilization for skin diseases. Understanding how socioeconomic status may impact access to and preferences for different forms of healthcare could add depth to the analysis.
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Competing Interests: None declared.
Published on: (9 August 2010)
Page navigation anchor for Prevalence of skin diseases in family medicine
Prevalence of skin diseases in family medicine
Andrea W.M. Evers, Nijmegen, The Netherlands
Other Contributors:
The comments of van der Wouden is justified in that we restricted our study to the chronic and recurrent skin diseases and did not take into account acute conditions like impetigo or dermato-mycosis. This was not so much an omission but a deliberate choice as our interest was in particular in the lasting individual impact of skin diseases. This impact is more determined by chronic than acute conditions. That this choice wou...
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The comments of van der Wouden is justified in that we restricted our study to the chronic and recurrent skin diseases and did not take into account acute conditions like impetigo or dermato-mycosis. This was not so much an omission but a deliberate choice as our interest was in particular in the lasting individual impact of skin diseases. This impact is more determined by chronic than acute conditions. That this choice would give a lower prevalence of skin diseases in family practice than when the diseases van der Wouden mentions had been included, is true. But his quest for the estimation of the ‘true’ prevalence would ask for more than just the inclusion of a few more diagnostic categories. The moluscae he would have liked to see included, evoke an interesting discussion of what is and what is not a disease: a mere mottle for one, a threatening problem for another. In our analysis, we focused on skin diseases that would in all fairness have an lasting impact on individual patients’ life. With our choice we may have erred on the safe side, knowing that it would make a welcome contribution to the limited literature of skin diseases in primary care, without providing the final word.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (4 August 2010)
Page navigation anchor for Prevalence underestimated
Prevalence underestimated
Johannes C van der Wouden, Rotterdam, The Netherlands
Research in skin diseases in general practice is a neglected area and this paper is a welcome addition to the existing literature. I wonder why the authors restricted themselves to the skin diseases they present, and did not include common disorders like impetigo, dermatomycosis and molluscum contagiosum. As a result of these omissions, the calculated prevalence of skin diseases as presented in general practice is probabl...
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Research in skin diseases in general practice is a neglected area and this paper is a welcome addition to the existing literature. I wonder why the authors restricted themselves to the skin diseases they present, and did not include common disorders like impetigo, dermatomycosis and molluscum contagiosum. As a result of these omissions, the calculated prevalence of skin diseases as presented in general practice is probably an underestimate of the true prevalence.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (3 December 2009)
Page navigation anchor for The role of patient satisfaction and adherence in skin diseases
The role of patient satisfaction and adherence in skin diseases
Andrea W.M. Evers, Nijmegen, The Netherlands
Other Contributors:
Skin diseases are a substantial part of the problems dealt with by family physicians. In response to our publication on the prevalence and health care use of skin diseases in family practice, Renzi and Maestroni emphasize the important role of an open doctoral-patient discussion to increase patient satisfaction and to discuss the use of CAM (complementary and alternative medicine) or problems with treatment adherence. In...
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Skin diseases are a substantial part of the problems dealt with by family physicians. In response to our publication on the prevalence and health care use of skin diseases in family practice, Renzi and Maestroni emphasize the important role of an open doctoral-patient discussion to increase patient satisfaction and to discuss the use of CAM (complementary and alternative medicine) or problems with treatment adherence. In line with Renzi and Maestroni, this and previous studies have shown that the use of CAM is particularly prone in patients who experience more limitations in daily life due to their condition (1,2). In addition, non- adherence is a well-known problem in dermatology (3-9). For example, we found that about 70% of patients with psoriasis reported that they were non-adherent at some stage (10). This relatively high level of non- adherence interfered with the effects of regular dermatological treatment, particularly the follow-up results after successful UVB treatment. The findings underline the need to integrate adherence assessment and to offer interventions that successfully increase patients’ commitment and self- managements skills when dealing with the instructions and advice given (family) physicians. A key to this is in assessing, early in the episode of care, patients’ expectations and their reasons to seek medical care, in addition to the diagnosis. Since there is evidence that non-adherence is also related to a lower quality of life and treatment-related factors, such as less satisfaction with treatment and fear of side effects (3-9), treatments directed at improving both the quality of life of patients and doctor-patient relationships might also improve treatment adherence and consequently treatment efficacy (11-13).
References
1. Verhoeven EWM, Kraaimaat FW, van Weel C, van de Kerkhof PCM, van der Valk, PGM, Duller P, Hoogen HJH, Bor J, Schers HJ, Evers AWM. Skin diseases in family medicine: prevalence and health care use. Ann Fam Med 2008, 6, 349-354.
2. Jacobs JWG, Kraaimaat FW, Bijlsma JWJ. Why do patients with rheumatoid arthritis use alternative treatments. Clin Rheumatol 2002, 20, 192-196.
3. Balkrishnan R, Carroll CL, Camacho FT, Feldman SR. Electronic monitoring of medication adherence in skin disease: Results of a pilot study. J Am Acad Dermatol 2003; 49: 651-654.
4. Benzi C, Picardi A, Abent D, Agostini E, Baliva G, Pasquini P. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol 2002; 138: 337-342.
5. Dunbar-Jacob J, Schlenk E. Patient adherence to treatment regimen. In: Handbook of Health Psychology (Baum A, Revenson TA, Singer JE eds) Lawrence Erlbaum Associates: London, 571-580, 2001.
6. van de Kerkhof PCM, de Hoop D, de Korte J, Cobelens SA, Kuipers MV. Patient compliance and disease management in the treatment of psoriasis in the Netherlands. Dermatology 2000; 200: 292-298.
7. Richards HL, Fortune DG, O'Sullivan TM, Main CJ, Griffiths CEM. Patients with psoriasis and their compliance with medication. J Am Acad Dermatol 1999; 41: 581-583.
8. Richards HL, Fortune DG, Griffiths CEM. Adherence to treatment in patients with psoriasis. JEADV 2006; 20: 370-379.
9. Serup J, KettisLindblad A, Maroti M, Kjellgren KI, Niklasson E, Ring L. To follow or not to follow dermatological treatment - A review of the literature. Acta Derm Venereol 2006; 86: 193-197.
10. Evers AWM, Kleinpenning MM, Smits T, Boezeman J, van de Kerkhof PCM, Kraaimaat FW, Gerritsen MJP. Non-adherence predicts long-term effects of narrow-band UVB therapy in patients with psoriasis. Arch Dermatol (in press).
11. Evers AWM, Kraaimaat FW, van Riel PLCM, de Jong AJL. Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: A randomized, controlled trial. Pain 2002; 100: 141-53
12. Evers AWM, Duller P, van de Kerkhof PCM, van der Valk PGM, de Jong EMGJ, Otero E. Effects of a brief multidisciplinary itch-coping programme for patients with atopic dermatitis. Acta Derm Venereol, 2009, 89: 57-63.
13. Williams A, Manias E, Walker R. Interventions to improve medication adherence in people with multiple chronic conditions: a systematic review. J Adv Nurs 2008; 63: 132-143.
Competing interests: None declared
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Competing Interests: None declared.
Published on: (3 November 2009)
Page navigation anchor for Chronic skin diseases and patient involvement in health care
Chronic skin diseases and patient involvement in health care
Cristina Renzi, Rome, Italy
Other Contributors:
Skin diseases often have an important impact on health related quality of life (QoL) and on health care costs. For example, the effects of atopic dermatitis on patients' QoL and psychosocial well-being are comparable to those of diabetes or hypertension (1,2). Verhoeven et al. highlight the relatively high prevalence of skin diseases encountered by family physicians, with 65.1% of patients affected by skin diseases seein...
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Skin diseases often have an important impact on health related quality of life (QoL) and on health care costs. For example, the effects of atopic dermatitis on patients' QoL and psychosocial well-being are comparable to those of diabetes or hypertension (1,2). Verhoeven et al. highlight the relatively high prevalence of skin diseases encountered by family physicians, with 65.1% of patients affected by skin diseases seeing only their family physician for the skin problem. Patients with more sever diseases and worst health-related QoL access health services more frequently. Interestingly, patients using complementary and alternative medicine (CAM) have the lowest level of QoL and more severe diseases.
In a recent study we examined attitudes and experiences regarding CAM on a sample of 573 dermatological patients, showing that patients satisfied with the information regarding the skin disease received by their physician were significantly less likely to use CAM (Odds Ratio (OR)=0.50; 95% Confidence Interval (CI) 0.31-0.79; p=0.006) (Renzi C et al., manuscript in preparation). One of the main reasons for using CAM was that patients were not satisfied with “conventional care” (26%). Only 36% of patients using CAM informed their physician. We have previously shown among a sample of 396 dermatological out-patients that satisfaction with care was increased by physicians’ ability to give explanations to patients (OR=5.21; 95%CI 2.7-10.0; p<0.001) and to show to care for patients' health (OR=1.92; 95%CI 1.1-3.7; p=0.048) (3). Dissatisfaction was associated with poor treatment compliance (OR=2.24; 95%CI 1.3-3.9; p=0.004) (4). Insufficient information, unexpressed patient preferences for some treatment options and prejudices or concerns regarding other treatments (e.g. corticophobia) can be associated with suboptimal disease management, increased use of healthcare resources, including CAM, use of non-evidence based treatments and negative health outcomes (2,5). Thus, the importance of an open doctor-patient discussion, including also questioning patients regarding possible CAM use, should be emphasized. This can also help prevent possible drug-herb interactions, considering that often patients do not disclose CAM use, if not directly asked (6). In order to optimize care, it is important to evaluate patients’ concerns and expectations, actively involving the patient in a shared treatment plan. This is particularly relevant for chronic diseases needing long term treatments and affecting QoL.
References
1) Carroll CL, Balkrishnan R, Feldman S. The burden of atopic dermatitis: impact on the patient, family and society. Pediatric Derm 2005; 3: 192-199.
2) Feldman S, Behnam SM, Behnam SE et al. Involving the patient: Impact of inflammatory skin disease and patient-focused care. J Am Acad Dermatol 2005; 53: S78-85.
3) Renzi C, Abeni D, Picardi A, Agostini E, Melchi CF, Pasquini P, Puddu P, Braga M. Factors associated with patient satisfaction with care among dermatological out-patients. Br J Dermatol 2001;145:617-623
4) Renzi C, Picardi A, Abeni D, Agostini E, Baliva G, Pasquini P, Puddu P, Braga M. Association of dissatisfaction with care and psychiatric morbidity with poor treatment compliance. Arch Dermatol 2002; 138: 337- 394.
5) Staab D, Diepgen TL, Fartasch M et al. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ 2006; 332: 933-938.
6) Shelley BM, Sussman AL, Williams RL, Segal AR, Crabtree BF. They don’t ask me so I don’t tell them: Patient-clinican communication about traditional, complementary and alternative medicine. Ann Fam Med 2009; 7:139-147.
Competing interests: None declared
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Competing Interests: None declared.