Information for Skin Problems in Primary Care (ISP-PC); a cluster-randomized controlled trial

Data
were collected in the context of a clinical trial to evaluate the effect of one
clinical evidence source, VisualDx, on skin problem outcomes in primary care
settings.

Methods:
A cluster-randomized controlled pragmatic trial was conducted in outpatient
clinics at University of Vermont Medical Center, Burlington Vermont.
Participants were primary care providers (PCPs) and their adult patients seen
for skin problems. The intervention was VisualDx, a clinical evidence
technology. PCPs were randomly assigned to the intervention or control groups.
Intervention PCPs agreed to use VisualDx as their primary evidence source for
skin problems. Control group PCPs agreed not to use VisualDx (usual care). Investigators collected outcome data by phone
at thirty-day intervals from patients seen by a participating provider for a
skin problem.

Provider
characteristics and randomized group allocation were merged with patient
reported data for analysis. Outcomes measured were: 1. patient-reported time
from index clinic visit to problem resolution, and 2. the number of follow-up
visits to any provider for the same problem.

Survival
analysis and Cox proportional hazards models assessed time to resolution. Wilcoxon-rank
sum tests and logistic regression compared the need for return appointments.

Results:
Thirty-two PCPs and 433 patients participated. In proportional hazards
modelling adjusted for provider clusters, the time from index visit to skin
problem resolution was similar in both groups (hazard ratio=0.92; 95%
confidence interval [CI]=0.70, 1.21; p=0.54). Patient follow-up appointments
did not differ significantly between groups (odds ratio=1.26; CI=0.94, 1.70;
p=0.29).

Conclusion:
There was no difference in skin problem resolution or number of follow-up
visits when PCPs used VisualDx.