Dermatologic care for urgent care patients not referred to dermatology

Summary: Abstract Body: Our previous study (DOI:10.1007/s00403-024-03662-1) on urgent care (UC) referrals to dermatology revealed significant discrepancies in diagnoses and treatment plans between UC providers and dermatologists. Surveyed dermatologists identified frequent treatment errors, particularly in corticosteroid and antibiotic prescribing practice. Building on these findings, this study analyzed 511 skin-related encounters from 8 University of Rochester UC sites that did not result in a dermatology referral (9/2022–3/2024). Analyses (Pearson chi-square and ANOVA at α=0.05) focused on diagnostic patterns, corticosteroid and antibiotic usage, and bacterial culture practices. The most common diagnoses were infections of the skin and subcutaneous tissue (27%), followed by rash (17%) and allergic contact dermatitis (ACD, 16%). In our previous study of referred patients, rash and skin infections were most commonly misdiagnosed by UC providers, suggesting the potential for diagnostic inaccuracies within this non-referred population. Oral antibiotics were prescribed in 34% of cases, but only 14% included a culture, with no significant association between antibiotic type and culture acquisition. Oral steroids were prescribed in 25% of cases (mean duration 9.5 ± 4.4 days), of which 9% also received antibiotics, mostly for infections or ACD. Oral steroids were prescribed most often for ACD (52%) and rash (20%). Treatment durations varied by diagnosis (p<0.0001), ranging from 12.2 ± 3.3 days for ACD to 4.9 ± 0.9 days for unspecified dermatitis. Overall, management concerns in the non-referred population mirrored those in referred patients, including lack of bacterial cultures with antibiotic prescriptions and frequent use of systemic corticosteroids, often with insufficient dosing when prescribed. These findings highlight the need for standardized treatment protocols and targeted education to enhance the quality of UC dermatologic care. Amanda B. Rodriguez Orengo¹, Christopher T. Richardson², Alison Moynihan², Clayton Green², Julie Ryan Wolf² 1. University of Rochester School of Medicine and Dentistry, Rochester, NY, United States. 2. Dermatology, University of Rochester Medical Center, Rochester, NY, United States. Clinical Research: Epidemiology and Observational Research