SKIN November 2018 Volume 2 Issue 6 Copyright 2018 The National Society for Cutaneous Medicine 407 RESEARCH LETTER Topical Corticosteroid Clinical Decision Support for Primary Care Providers: There’s an App for That! Laura Burbach1, Melissa Butt, MPH 2, Jessica Butts, MD3, Todd Felix, MD3, Daniel Schlegel, MD3, Kassidy Shumaker2, Joslyn S Kirby, MD, MS, Med2 1Penn State College of Medicine, Hershey PA 2Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey PA, 3Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA Literature has indicated that 20-36% of patients in PCP offices have dermatologic conditions1. PCPs have been shown to prescribe inappropriately high-potency topical corticosteroids (TCS), or, conversely, inappropriately low-potency TCS.2 In addition, drug costs may be higher if multiple small tubes are dispensed over the treatment course.3 Importantly, mobile devices and applications provide significantly increased access to point-of-care tools and, with use by providers, demonstrate better clinical decision-making and improved patient outcomes.4,5 The focus of this study was to develop and evaluate an application (‘app’) designed as a clinical decision support for PCP use of TCS. The app was developed using clinical practice guidelines for topical corticosteroid use. App design and functionality was iteratively developed by a multidisciplinary group of professional app designers (3), PCPs (3), and dermatology providers (3). A study of the app was performed with PCPs to determine changes in potency, vehicles and amount of corticosteroid prescriptions before and after app use (CorticoCream Calculator, https://www.padermatology.org/corticream- calculator.html). The study was approved by the Penn State institutional review board. PCPs were recruited on June 7, 2017, then 3 months later their prescription records were retrieved for the three months before and after the recruitment date (March 7- September 7, 2017). Surveys collected participants’ perceptions of app utility, performance, and PCPs’ perceptions about their personal confidence in prescribing TCS. Descriptive statistics were performed and the t test, Chi-square test or Fisher’s exact test were used to determine statistical significance. Study sample characteristics are reported in Table 1. There was an increase in the percentage of prescriptions for intermediate sized (45-170g) units, with a baseline percentage of 48.6% and an increase to 58.6%. There was a decrease in the percentage of prescriptions for small sized (15-30g) units, with a baseline percentage of 42.0% and a decrease to 36.3% (p=.07). There was also a shift away from low-potency towards high-potency TCS (Figure 1). Low- potency prescriptions decreased from 25% to 22.6% and high-potency increased from 16.0% to 19.0% after initiating app use, but weren’t statistically significant (p=.68). There SKIN November 2018 Volume 2 Issue 6 Copyright 2018 The National Society for Cutaneous Medicine 408 were shifts in the choice of vehicles, with an increase from 4.7% to 7.1% for shampoo, gel, solution and foam, which are sometimes preferred for hair-bearing areas (p=.55). Survey results, collected at 0, 1, and 3 months of application use, showed an increase in certainty of prescribing appropriate quantity and vehicle. Certainty for quantity increased from 30.8% to 46.1% (p=.27). Similarly, certainty for vehicle increased from 30.8% to 61.5% (p=.29). Lastly, the application was described as “very easy to use,” “intuitive” and “an excellent tool,” with one participant commenting it “broadened [their] knowledge of what to use and how much to give.” In conclusion, a clinical decision app increased PCPs’ perception of certainty when prescribing steroids and resulted in nearly significant differences in amounts of TCS prescribed to patients. There were Figure 1: Potency, vehicle and volume prescription habits before and after use of application. SKIN November 2018 Volume 2 Issue 6 Copyright 2018 The National Society for Cutaneous Medicine 409 changes, though not statistically significant in higher potency steroids and more vehicle diversity associated with app use. This app could aid PCPs in their management of patients and reduce unnecessary appointments to dermatologists. This would offer dermatologists more availability for patients with urgent concerns or truly recalcitrant dermatoses. Conflict of Interest Disclosures: None. Funding: This study was supported in part by a research grant from Pfizer Independent Grants for Learning and Change to the Pennsylvania Academy of Dermatology and Dermatologic Surgery. Pfizer had no responsibility for or input into the any analyses, interpretations, or conclusions. Corresponding Author: Joslyn Kirby, MD, MS, MEd Penn State Hershey Department of Dermatology 500 University Drive Mail Code HU14 Hershey PA Email: jkirby1@pennstatehealth.psu.edu References: 1. Federman DG, Concato J, Kirsner RS. Comparison of dermatologic diagnoses by primary care practitioners and dermatologists. A review of the literature. Archives of family medicine. Mar-Apr 1999;8(2):170-172. 2. Balkrishnan R, Cook JM, Shaffer MP, Saltzberg FB, Feldman SR, Fleischer AB, Jr. Analysis of factors associated with prescription of a potentially inappropriate combination dermatological medication among US outpatient physicians. Pharmacoepidemiology and drug safety. Mar 2004;13(3):133-138. 3. Skojec A, Foulke G, Kirby JS. Variation in the Cost of Generic Topical Corticosteroids. JAMA dermatology. Aug 19 2015. 4. Aungst TD. Medical applications for pharmacists using mobile devices. The Annals of pharmacotherapy. Jul-Aug 2013;47(7-8):1088-1095. 5. Ventola CL. Mobile devices and apps for health care professionals: uses and benefits. P & T : a peer-reviewed journal for formulary management. May 2014;39(5):356-364. mailto:jkirby1@pennstatehealth.psu.edu