Skin examinations and skin cancer prevention counseling by US physicians: A long way to go

被引:47
作者
Feldman, SR [1 ]
Fleischer, AB
机构
[1] Wake Forest Univ, Sch Med, Westwood Squibb Ctr Dermatol Res, Winston Salem, NC 27103 USA
[2] Wake Forest Univ, Sch Med, Dept Dermatol, Winston Salem, NC 27103 USA
[3] Wake Forest Univ, Sch Med, Dept Pathol, Winston Salem, NC 27103 USA
关键词
D O I
10.1067/mjd.2000.105559
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: Nonmelanoma skin cancer and actinic keratoses may be partially preventable by physician counseling. Objective: The purpose of this study was to assess the frequency of counseling for skin cancer prevention. Methods: Data on skin cancer counseling and skin examinations were obtained from representative visits to outpatient physicians in the United States from the 1997 National Ambulatory Medical Care Survey. A limitation of the skin examination data is that the extent of the skin examination was not reported. Results: Skin examinations occurred in 60 million (8.6%) of 703 million office visits, and skin cancer prevention counseling or education occurred in 12 million visits (1.5%). For patients younger than 20 years, such prevention counseling occurred in only 1.0% of 169 million visits. For those patients with a current or previous history of nonmelanoma or melanoma skin cancer or actinic keratosis (high-risk patients) identified by the treating physician, 2.8 million (35%) of 7.9 million patients received such counseling. In high-risk patients, dermatologists provided such counseling at 41% of visits, compared with 24% for general and family practice, 9.3% for otolaryngology, 13% for general surgery and 7.7% for internal medicine. In such high-risk patients, skin examinations were performed at 78% of dermatology visits, 69% of otolarynogolgy visits, 36% of general surgery visits, and 27% of family physician visits. Capitation did not lead to greater primary preventive practices; skin cancer prevention counseling occurred in 4% of high-risk capitated patients compared with 38% of noncapitated patients. Conclusion: Physicians provide skin cancer prevention counseling or education at fewer than half of visits for high-risk patients. High-risk patients are likely to receive skin cancer prevention messages depending on the specialty of physician that they visit in roughly the following scheme: dermatologists > family physicians >all other specialties. Economic restraints within managed care systems may affect their "health maintenance" function.
引用
收藏
页码:234 / 237
页数:4
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