ABSTRACT
The article highlights different educational and practice gaps in infectious diseases as they pertain to dermatology. These gaps include the use of antibiotics in relation to atopic dermatitis and acne vulgaris, treatment of skin and soft tissue infection, and diagnosis and treatment of onychomycosis. In addition, practice gaps related to use of imiquimod for molluscum contagiosum, risk of infections related to immunosuppressive medications and rates of vaccination, and the use of bedside diagnostics for diagnosing common infections were discussed.
Subject(s)
Acne Vulgaris/drug therapy , Anti-Bacterial Agents/therapeutic use , Dermatology/education , Skin Diseases, Infectious/therapy , Soft Tissue Infections/therapy , Adjuvants, Immunologic/therapeutic use , Aminoquinolines/therapeutic use , Antifungal Agents/therapeutic use , Dermatitis, Atopic/drug therapy , Dermatology/standards , Humans , Imiquimod , Immunosuppressive Agents/adverse effects , Molluscum Contagiosum/drug therapy , Onychomycosis/diagnosis , Onychomycosis/drug therapy , Reagent Kits, Diagnostic/statistics & numerical data , Skin Diseases, Infectious/diagnosis , VaccinationABSTRACT
BACKGROUND: The introduction of buprenorphine as office-based treatment for opioid dependence was designed to expand treatment capacity, but virtually there are no data about use of this medication in rural areas. METHODS: The survey of the first cohort of physicians in rural Washington State who obtained buprenorphine waivers (2002-2010) to determine the volume of treated patients, physician appraisal of the efficacy of this treatment, and perceived barriers to treatment was conducted. Twenty-four (73 percent) of the 33 rural buprenorphine-certified physicians practicing in the state were interviewed in 2010. RESULTS: Twenty physicians (83 percent) were actively prescribing buprenorphine/naloxone for treatment of addiction. Those currently prescribing averaged 23 active patients and had treated 125 patients since certification. All respondents reported that buprenorphine was efficacious in the treatment of addiction and 95 percent recommended that other rural colleagues adopt buprenorphine treatment. The following four major barriers were cited: 1) lack of adequate financial support from Medicaid, the largest source of third-party coverage for these patients; 2) unavailability of local mental health and behavioral addiction treatment services; 3) difficulty in finding consultants to assist in managing complex patients; and 4) shortages of other rural physicians providing this service. CONCLUSIONS: Buprenorphine is viewed as a highly effective treatment of opioid addiction by early adopters in rural Washington State, but relatively few rural physicians currently provide this service. Inadequate insurance coverage, a shortage of effective links with consultants and colleagues, and the lack of mental health services are persistent barriers to the use of this modality in rural Washington State.