Factors influencing alopecia areata treatment decisions: A qualitative assessment.

Background: Alopecia areata (AA) is a disease of hair loss in which patients may benefit from comprehensive understanding of AA's disease process and therapeutic options during treatment decision-making. Objective: Determine factors influencing patients' AA treatment decision-making. Methods: Qualitative interviews were conducted using semi-structured interview guides. Interviews were coded using inductive thematic analysis. Results: Twenty-one participants with AA were interviewed. Coding interrater reliability was κ = 0.87-0.91, indicating strong-almost perfect agreement. Participants faced multiple barriers, including lack of access to health care (n = 10, 47.6%) and lack of transparency about their condition and treatment options (n = 9, 42.9%). Information about AA was sought from primarily the internet (n = 15, 71.4%) and physician recommendation (n = 15, 71.4%). When choosing AA treatments, patients often considered treatment efficacy (n = 21, 100%), safety (n = 21, 100%), and convenience of use (n = 20, 95.2%). Limitations: Referral and regional biases may be present and limit generalizability. Conclusions: Patients with AA face various challenges including medical uncertainty and lack of information. Patients need trustworthy and accessible sources of information regarding their treatment that also take into consideration their preferences and values.

Evaluating hospital consumer-friendly price-estimator tools for shoppable services within dermatology.

A recent mandate by the Centers for Medicare and Medicaid Services (CMS) required hospitals to publish prices online. This study examined the utility of CMS-mandated price estimators for dermatology procedures. Chargemasters and price-estimator tools from the five largest hospitals in each state (n = 250) were reviewed for accessibility. Price estimators were also searched for the presence of dermatologic procedures and their estimated prices. Of the 250 hospitals included, 89.6% of chargemasters and 92.8% of price estimators were accessible. Of the available chargemasters and price estimators, 98.7% and 63.8% contained pricing data on dermatologic procedures, respectively. The most common dermatology procedures listed were debridement of subcutaneous tissue (CPT 11042) with a median price of $1,135.50 (IQR $577-$3533.67; n = 80), followed by simple incision and drainage of skin abscess (CPT 10060) with a median price of $956.00 (IQR $465.50-$6506.00, n = 79), and single punch biopsy of skin (CPT 11104) with a median price of $506.06 (IQR $356.50-$922.08, n = 29). Although price estimator tools are widely available in patient-friendly and searchable formats, they are not optimized for shoppable dermatologic services. Adding more dermatologic procedures to patient-friendly price-estimator tools can help patients directly realize savings from price shopping.

Variability of over-the-counter spending on acne treatment across race and demographic characteristics.

Acne is a common skin condition that is associated with long-term dermatologic and psychologic morbidities if left untreated. In this study, a survey was distributed via Amazon Mechanical Turk to evaluate for out-of-pocket costs associated with over-the-counter (OTC) acne treatment. A total of 515 respondents with acne were included, of whom 84% used OTC products, spending on average $121.99 ± $115.69 in the past year. Additionally, on average, Black respondents spent more on OTC products than those of other races, and there was a positive correlation between income and expenditure on OTC products. Consistent with the literature, we found that many patients self-treat with multiple OTC products and out-of-pocket costs are significant.

Digital scribe utility and barriers to implementation in clinical practice: a scoping review.

Electronic health records (EHRs) allow for meaningful usage of healthcare data. Their adoption provides clinicians with a central location to access and share data, write notes, order labs and prescriptions, and bill for patient visits. However, as non-clinical requirements have increased, time spent using EHRs eclipsed time spent on direct patient care. Several solutions have been proposed to minimize the time spent using EHRs, though each have limitations. Digital scribe technology uses voice-to-text software to convert ambient listening to meaningful medical notes and may eliminate the physical task of documentation, allowing physicians to spend less time on EHR engagement and more time with patients. However, adoption of digital scribe technology poses many barriers for physicians. In this study, we perform a scoping review of the literature to identify barriers to digital scribe implementation and provide solutions to address these barriers. We performed a literature review of digital scribe technology and voice-to-text conversion and information extraction as a scope for future research. Fifteen articles met inclusion criteria. Of the articles included, four were comparative studies, three were reviews, three were original investigations, two were perspective pieces, one was a cost-effectiveness study, one was a keynote address, and one was an observational study. The published articles on digital scribe technology and voice-to-text conversion highlight digital scribe technology as a solution to the inefficient interaction with EHRs. Benefits of digital scribe technologies included enhancing clinician ability to navigate charts, write notes, use decision support tools, and improve the quality of time spent with patients. Digital scribe technologies can improve clinic efficiency and increase patient access to care while simultaneously reducing physician burnout. Implementation barriers include upfront costs, integration with existing technology, and time-intensive training. Technological barriers include adaptability to linguistic differences, compatibility across different clinical encounters, and integration of medical jargon into the note. Broader risks include automation bias and risks to data privacy. Overcoming significant barriers to implementation will facilitate more widespread adoption. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12553-021-00568-0.