How Dermatologically Aligned Are Territory Doctors? Assessing Dermatology Referrals in Darwin for Diagnostic and Therapeutic Concordance.

Abstract

Background/objectives: A significant number of dermatological presentations in Australia are managed by general practitioners and non-dermatologist health professionals. This audit examines the agreement between referring physicians and dermatologists in a tropical regional setting to identify opportunities for collaborative education and support.

Methods: A retrospective audit was conducted at a privately billing dermatology practice in Darwin, Northern Territory of the referrals for 479 patients from January to March 2022. Particular attention was given to the concordance in diagnoses and treatments initiated. A subset of 131 referrals focused on skin cancer surveillance.

Results: Only a third of skin cancer referrals included a provisional diagnosis, but, where provided, this corresponded with the dermatologists' assessments 62% of the time. There was 100% diagnostic concordance for presentations of melasma, molluscum/verruca and hidradenitis suppurativa. For acne, hyperhidrosis, and vitiligo, concordance rates ranged from 72.7%-93%. However, treatment concordance was low across all non-skin cancer conditions, with no treatment prescribed by the referring practitioner for more than one quarter of all patients.

Conclusions: This audit identified deficiencies in the diagnosis of skin cancer and the management of other dermatological conditions, indicating opportunities for interprofessional collaboration with targeted education to enhance the management and treatment outcomes of dermatological conditions in the Northern Territory.