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.