Characterizing breast conditions at an open-access breast clinic in South Africa: a model that is more than cancer care for a resource-limited setting
Many factors such as cost have been used by managed care systems to limit patient access to specialty care, including dermatology. To date, however, patients' opinions regarding these decisions have not been analyzed. The purpose of the study was to survey patient opinions regarding the efficacy, costs, and desirability of gatekeeper-mediated versus direct access to dermatologic specialty care. One hundred fifteen of 150 consecutive patients who were seen in an outpatient dermatology clinic completed an anonymous survey concerning their current visit. They were asked about referral to the dermatologist by other physicians, number of prior physician visits, and efficacy of therapies received. Patients rated their level of satisfaction with generalist versus specialist care for their condition and evaluated the importance of direct access to dermatologic specialty care. Thirty-nine percent of respondents (42 of 108) were on their first visit to the dermatologist for their current condition. One half of respondents (57 of 115) had previously seen another physician for this condition. Thirty percent (34 of 115) had been referred to the dermatologist by another physician, most often a family practitioner or internist. Two thirds (38 of 57) of those seen by a previous physician had received therapy from that physician, but only one third (12 of 35) believed it to have been of any benefit. Twenty-three percent (11 of 47) claimed to have incurred more than five visits to the other physician before seeing the dermatologist. Twenty-four percent of patients (12 of 50) were "very satisfied" with the previous physician's care compared with 89% (100 of 112) with the dermatologist's care. Only 6% of respondents (7 of 122) believed a generalist could adequately treat their skin disease. Eighty-seven percent (100 of 115) described direct access to dermatology as being "very important" to their health care. The results of this study suggest that many patients may prefer dermatologic specialists over generalists as primary caregivers for diseases of the skin. They may favor direct access to dermatologic specialty care for its efficacy and for cost and time savings.