A pilot study to compare the ability of health care practitioners to recognise and treat a range of skin conditions

Background
Recent data suggests that skin conditions were the most common reason for patients to consult their GP with a new problem1. Healthcare practitioners (HCPs) including pharmacists and nurses are recognized possible alternative sources to the GP for advice and treatment. However little is known about their ability to recognise and treat skin conditions. The aim of the study was to compare the ability of these HCPs to identify and suggest suitable first line management strategies for a number of skin conditions. Ethical approval for the study was sought and deemed unnecessary.
Method
HCPs were invited to participate in the study remotely at a specifically designed website (www.hpdiagnosticstudy.co.uk.). Among the skin conditions included were melasma, pitted keratolysis, tinea corporis, a verruca, scabies, molluscum contagiosum, pityriasis rosea, polymorphic eruption of pregnancy (presenting as possible urticaria), a basal cell papilloma and pompholyx eczema. Participants were recruited using local primary care research networks. Pharmacists were additionally recruited by an advertisement in the community pharmacy press. All participants accessed the site through an electronic link sent by email and were given 7 days to complete the test, followed up by a reminder 7 days later. The web site consisted of 10 peer-reviewed case studies including a digital image of the condition and associated case history. Participants were required to identify: 1) the condition 2) the features supporting the diagnosis 3) an appropriate first-line treatment option. A summative dermatology total score was computed for each participant for correctly identifying all three aspects. Since the groups were unmatched, analysis of covariance (ANCOVA) was used to compare the mean total dermatology scores between the different HCPs. Covariates were identified by computing a Pearson’s r correlation between the total scores and potential confounders.
Results
A total of 60 HCPs (20 pharmacists, GPs and practice nurses) took part in the study. There were significant associations (p<0.01) between total dermatology score and gender (r = .49) and previous exposure to the skin condition (r = .50). These were therefore included as covariates in the ANCOVA model. The mean total dermatology scores for pharmacists, nurses and GPs were 16.3, 15.6 and 19.9 respectively and this difference was significant, F (2, 55) = 5.83, p = 0.005. The covariate gender also had a significant effect on total dermatology score, F (1, 55) = 7.11, p = 0.01. Post-hoc Sidak testing revealed that the difference in mean scores between GPs and both nurses and pharmacists was significant (p < 0.05).
Conclusion
These preliminary results not surprisingly suggest that the GP is the most appropriate source of advice and treatment for patients with skin problems. This pilot study suggests that pharmacists and practice nurses have similar diagnostic abilities for a number of common skin conditions however further investigation embracing a larger sample, is required to substantiate this conclusion
Reference
1. Schofield JK, Fleming D, Grindlay D, Williams H. Skin conditions are the commonest new reason people present to general practitioners in England and Wales. Br J Dermatol. 2011;165(5):1044-50.