Assessing adherence to evidence-based guidelines of care for acne vulgaris

Abstract

Background

Care guidelines are developed to assist in performing high-quality, cost-effective care.

Objective

This study was designed to assess the adherence to evidence-based guidelines of care for acne.

Methods

For acne treatment, we analyzed 2008–2015 National Ambulatory Medical Care Survey visits. For each medication mention, a grade was assigned based upon the American Academy of Dermatology 2007 treatment guidelines.

Results

Most encounters achieved the grade of A, regardless of specialty or patient population. A proportion of visits involved the use of oral antibiotics monotherapy, which occurred at 11.7% (8.6–14.8) dermatologist and 25.6% (12.4–38.8) of non-dermatologist visits. Although not addressed in the 2007 guidelines, this practice was not recommended in the updated 2016 guidelines.

Limitations

Other factors influencing prescribing behaviors cannot be completely assessed using extant data.

Conclusion

This study demonstrates that nearly all physicians adhered to the 2007 guidelines. Many prescribed antibiotic monotherapy a practice not supported by the evidence.

Capsule summary

• Although acne practice guidelines are published, adherence to these guidelines is unknown.

• Using a grading system analogous to the United States A to F system, virtually all providers receive a grade of A. We expect that the grade will be lower in the future.

Keywords:

• Dermatology
• acne vulgaris
• health services research
• guideline adherence
• antibiotic stewardship
• evidence-based medicine

Disclosure statement

Dr. Dunaway has no conflicts. Dr. Fleischer is a consultant for Dermavant, Incyte, Qurient, SCM Life science. He is an investigator for Galderma, Menlo, Trevi and XBiotech. He has no other potential conflicts including Honoraria, Speakers bureau, Stock ownership or options, Expert testimony, grants, patents filed, received, pending, or in preparation, royalties, or donation of medical equipment.

IRB statement

Human data were deidentified and from CDC public use datasets.