Purpose

This study was designed to assess the adherence to evidence-based guidelines of care for atopic dermatitis (AD).

Methods

To characterize AD treatment in the United States, ambulatory visits from the 2006-2015 National Ambulatory Medical Care Survey were analyzed. For each medication prescribed, a grade was assigned on the basis of the American Academy of Dermatology treatment guidelines for topical and systemic medications. Considering all visit prescriptions, I calculated a composite grade, analogous to the US academic grading system (scores A-F).

Results

I noted prescribing differences across specialty groups. Systemic corticosteroids were more likely to be prescribed by family and general physicians and less likely by pediatricians. Dermatologists were more likely than other specialties to prescribe nonsedating antihistamines, which lack a guideline base supporting their use. Depending upon modeling of care assumptions, all physician specialty visits earned mean guideline-based grades of B or C in their care of AD patients.

Limitations

The clinical, social, and demographic factors influencing prescribing behavior cannot be completely assessed by using extant data.

Conclusions

This preliminary study demonstrates that physicians might benefit from reviewing guidelines of care; there might be an educational gap in the implementation of these guidelines.

中文翻译：

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在美国以非门诊性特应性皮炎治疗的护理指南为基础的基于指南的药物分级

目的

本研究旨在评估对特应性皮炎（AD）的循证护理指南的依从性。

方法

为了表征美国的AD治疗，分析了2006-2015年国家门诊医疗调查中的门诊就诊情况。对于每种处方药，根据美国皮肤病学会局部和全身药物治疗指南分配等级。考虑到所有访问处方，我计算了一个综合评分，类似于美国的学术评分系统（分数AF）。

结果

我注意到不同专业群体之间存在差异。全身性皮质类固醇激素更可能由家庭医生和普通医师开具处方，而儿科医生的可能性较小。皮肤科医生比其他专科医师更愿意开具非镇静抗组胺药，因为后者缺乏支持其使用的指南基础。根据护理假设的模型，所有医师专科就诊AD患者均获得基于指南的B或C级平均评分。

局限性

通过使用现有数据无法完全评估影响处方行为的临床，社会和人口统计学因素。

结论

这项初步研究表明，医师可能会从审查治疗指南中受益。这些准则的实施可能在教育上存在差距。