Dermatology practice in primary health care services: where do we stand in the Middle East?

BACKGROUND There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field. OBJECTIVE The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders. MATERIAL AND METHODS Physicians at university-hospital primary-care clinics were asked to answer a multiple-choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed. RESULTS Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P = 0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04). CONCLUSION PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of health care.