Should patients see the dermatologist together?

NEW YORK (Reuters Health) - If you’re frustrated by long waits to see a dermatologist, you and your skin doctor might want to consider a group appointment, a new study in the Archives of Dermatology shows.

Researchers looked at shared medical appointments, which are an increasingly popular approach to improving the quality and efficiency of patient care. These appointments typically involve having patients with similar medical concerns (for example, needing evaluation for a suspicious mole or acne treatment) watch a film or PowerPoint presentation on their condition, meet in a group with a nurse, and then meet individually with a physician.

At the same time, Dr. James G. H. Dinulos of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues note, “access in dermatology is a growing problem.” On average, the researchers say, a patient will need to wait 33 days to see a dermatologist, and 53 days for an appointment with a dermatologist at an academic clinic.

In the current study, published in the Archives of Dermatology, Dinulos’ team looked at 11 different shared medical appointment types offered in five of the medical center’s departments to examine whether the approach was indeed cost-effective. Their study included 301 shared appointments, including 2,045 patients.

They found that doctors saw more patients per hour and generated more profit in the shared medical appointments than in the individual appointments.

Overall, doctors saw nearly six more patients per hour and made about $700 more in profits with the group appointments compared to the traditional appointments. However, the difference between the two approaches was greatest in dermatology; additional profits per hour were around $1,000 for dermatology shared medical appointments, while doctors saw nearly eight more patients an hour.

The researchers did not compare the quality of care in group appointments. However, the study “demonstrates that access, patient care, and the economic bottom line are by no means antithetical,” the researchers note. Shared appointments “may be a powerful tool to simultaneously improve each of these important measures.”

In an editorial accompanying the study, Dr. Jack S. Resneck Jr. of the University of California, San Francisco, and Dr. Marta VanBeek of the University of Iowa in Iowa City point out that many factors must be considered in determining whether shared medical appointments are practical or successful, including doctors’ willingness to give up some counseling time to other health care professionals.

Patients “may also vary in their willingness to reduce physician contact time, desire to be counseled by a non-physician, willingness to wait for a group counseling session after completing a physician visit, and comfort level with the loss of privacy inherent in group counseling,” they add.

SOURCE: here Archives of Dermatology, April 2010.