SAN DIEGO (FRONTLINE MEDICAL NEWS) – A new study finds that primary diagnoses of atopic dermatitis (AD) are made hundreds of thousands of times in United States emergency departments each year.

The numbers appear to be rising along with costs, researchers reported, and there are signs of disparities, with poorer people more likely to have an ED visit with a primary diagnosis of AD. The study was presented in a poster at the annual meeting of the American Academy of Dermatology.

“Access to outpatient dermatologic care needs to be improved,” study investigator Jonathan I. Silverberg, MD, PhD , of the department of dermatology, Northwestern University, Chicago, said in an interview. “Since AD is a chronic disorder that can be managed in the outpatient setting most of the time, it is likely that improved outpatient access and care and tighter control of AD would result in fewer [ED] visits and a considerable costs savings in the long run.”

He and his coauthor, Lauren Kwa, also with the department of dermatology at Northwestern, conducted the analysis to better understand the role of AD in emergency care. “Many AD patients experience severe, unpredictable flares and worsening chronic disease that warrant urgent treatment,” Dr. Silverberg said. “However, patients typically don’t have instant access to outpatient dermatological care and may be forced to turn to the urgent care setting.”

Indeed, he noted, “previous U.S. population–based studies showed that people with AD have higher odds of [ED] utilization than the rest of the population.”

He and Ms. Kwa examined 2006-2012 data from the Nationwide Emergency Department Sample, which includes information on about 20% of all emergency visits in the United States.

During that period, there were 1.86 million ED visits with a primary diagnosis of AD. The annual weighted prevalence of primary diagnoses of AD stayed fairly stable through the period, ranging from 2,589 to 2,769 per 1 million visits. However, the weighted prevalence of secondary AD diagnoses grew steadily from 1,227 per 1 million visits in 2006 to 1,533 per 1 million visits in 2012.

The researchers estimated that the total cost of annual costs of AD-related ED visits grew from $86.9 million in 2006 to $172.8 million in 2012 (P less than .05).

The study also linked primary diagnoses of AD to having Medicaid insurance or being uninsured, being poorer, or visiting hospitals in “micropolitan” areas (small urban communities such as Bozeman, Mont., and Durango, Colo.).

The study did not examine what medications were prescribed in the ED. However, Dr. Silverberg said, “my anecdotal experience has been that many AD patients are prescribed systemic steroids by nondermatologists in the [ED] setting. While these are rapidly effective, they typically have short-lived efficacy and result in rebound flares upon cessation. Patients are rarely counseled on appropriate skin care techniques or given long-term treatment approaches in the [ED] setting, which fails to achieve adequate long-term disease control.”

What’s next? “We are now studying how AD severity, disease course, and treatment impact [ED] utilization for AD,” Dr. Silverberg said.

No specific study funding was reported. He and Ms. Kwa report no relevant disclosures.

SOURCE: Silverberg, J et al. Poster 7021 .


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