Treatment and referral patterns of patients with atopic dermatitis from the Danish primary care system to the tertiary care system

Background: Patients with atopic dermatitis (AD) are mostly managed by general practitioners (GPs) and practicing dermatologists (PDs) in Denmark. In cases of severe and refractory AD, the primary physician can refer the patient to a specialised dermatology department. Objectives: Aim of the study was to investigate treatment at the time of referral to a specialised dermatology department and the cause stated by the GP in a Danish cohort of AD patients referred to the Department of Dermatology, Aarhus University Hospital from 2019 to 2021. Methods: One hundred and thirty cases were randomly selected via diagnosis codes for AD. Information regarding the cause for referral and treatment given at time of referral was obtained from medical records. 18 cases were excluded due to missing referral in the patients' medical records, other diagnosis than AD or treatment initiation before 2019. The final cohort consisted of 112 cases. Differences between patients referred from GP and PD were analysed with Fisher's exact test. Results: Most cases were referred by PDs (45.5%) and GPs (24.1%). GPs primarily referred due to acute flare-ups in need of treatment (40.7%), and PDs due to lacking disease control (64.7%), (p-values < 0.0018). GPs generally included more descriptive information in their referrals than PDs, however, only the difference in mentioning sleep disturbance was significant (p-value = 0.0144). Topical corticosteroids were the preferred treatments before referral regardless of the referring doctor, with no statistical differences. Topical calcineurin inhibitors were significantly more used among PD-referred patients compared to GP-referred patients (p-value = 0.0018). Systemic therapy was initiated in 45 patients (40.2%) at the tertiary hospital with no differences between referral from either GPs or PDs. Conclusions: The study identified few differences in the referral pattern of AD to a tertiary treatment center from GPs and PDs. No major deviations from Danish guidelines were found.