Identifying care gaps and referral patterns in acute dermatology at urgent care centers.

Limited urgent access to board-certified dermatologists drives patients to seek dermatologic care at urgent care centers (UCC). UCC are staffed by clinicians with comparatively limited dermatology training, often resulting in lower quality care for acute dermatology conditions. Using a retrospective cohort of 839 referrals, this study investigates health care referral outcomes for patients seeking dermatologic care at UCC. We further surveyed five dermatologists on the appropriateness of UCC referral and UCC treatment plans in a subset of 40 referrals, as well as the feasibility of referral management by dermatology e-consultation (eConsult). Most patients referred by UCC did not complete an in-person dermatology evaluation (56.5%). Of those that completed an in-person dermatology evaluation, only 29.1% of UCC diagnoses were concordant. While our surveyed dermatologists (≥3/5 consensus) determined only 20% of UCC referrals had appropriate treatment plans, they found most referrals (92.5%) could have been managed with an eConsult with only 5.0% requiring an urgent in-person dermatology evaluation. These data reveal several practice gaps in dermatological care delivery in UCC and inefficiencies in the urgent referral process.