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General practice registrars' management of and specialist referral patterns for atopic dermatitis

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posted on 2023-05-21, 10:46 authored by Willems, A, Tapley, A, Fielding, A, Tng, V, Holliday, EG, van Driel, ML, Ball, JI, Davey, AR, Kristen FitzGerald, Spike, NA, Magin, PJ

Background: Atopic dermatitis (AD) is a common presentation in the general practice (GP) setting. Implementation of appropriate referral pathways is instrumental for best patient care and is an essential skill for Australian GP registrars.

Objectives: We aimed to explore the prevalence and associations of GP registrar referrals to specialists for AD management.

Methods: A cross-sectional analysis utilizing data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study that documents in-consultation clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors associated with referrals for AD were established using logistic regression.

Results: A total of 2,783 registrars (96% response rate) provided data from 381,180 consultations from 2010 to 2019. A total of 3,285 (0.55%) of 595,412 diagnoses managed were AD, of which 222 (6.8%) resulted in referral. Of these referrals, 70% were to dermatologists, 17% to allergists/immunologists, and 10% to pediatricians. Associations of referral included registrar female gender, patient age, longer consultation duration; an established (rather than new) AD diagnosis; supervisor advice being sought; and learning goals being generated.

Conclusions: Both registrar and patient factors influence AD referral patterns. Registrars referred established rather than newly diagnosed AD, suggesting a level of comfort in initial management. Referral was associated with longer consultations, seeking supervisor advice, and generation of learning goals-suggesting these are more complex presentations and, possibly, registrar learning opportunities. A significant proportion of referrals were to non-dermatologist specialists. The implication of this for optimal patient care is a subject for further study.


Publication title

Dermatology Practical & Conceptual








Tasmanian School of Medicine


International Dermoscopy Society

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© 2021 Willems et al. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) License ( This license allows re-users to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.

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