Faculty Bibliography

BACKGROUND:Prescription opioid use often precedes opioid misuse, abuse, and addiction. OBJECTIVE:To characterize the national opioid prescription practices of Mohs surgeons, with general dermatologists serving as a comparison group. METHODS:A retrospective cross-sectional study using Medicare prescription data to analyze opioid prescription characteristics. RESULTS:In 2014, 2,190 Mohs surgeons prescribed a total of 86,526 opioids, whereas 10,347 non-Mohs dermatologists prescribed 45,033 opioids. Among Mohs surgeons, 51.8% prescribed more than 10 opioids, whereas 93.3% of non-Mohs dermatologists prescribed 0 to 10. The estimated opioid prescription rates for Mohs surgeons and non-Mohs dermatologists were 5.9% and 0.7%, respectively. Among those prescribing at least 10 opioid claims, the mean number of opioids supplied and mean opioid prescription rate was 72.4 and 13.5, respectively, for Mohs surgeons versus 32.5 and 5.1 , respectively, for non-Mohs dermatologists. The mean days' supply of opioids was 3.9 for Mohs surgeons versus 7.9 for non-Mohs dermatologists. There was a minimal-to-moderate association between the number of procedures performed and the number of opioids prescribed. Men and Mohs surgeons located in southern states tend to prescribe a greater number of opioids. CONCLUSION/CONCLUSIONS:Mohs surgeons prescribed short courses of opioids and less than both the national average and providers that care for patients in pain.

Objectives: Antibiotics are commonly used in dermatology for infectious and inflammatory diseases, and dermatologists prescribe the most antibiotics per physician of any specialist in the United States (US). While oral antibiotics are effective for many conditions, adverse effects and increase in resistance are important public health issues. The purpose of this study is to examine trends in oral antibiotic prescription by US dermatologists using Medicare claims. Materials and Methods: Retrospective review using publicly available Medicare Part D prescriber public use files from 2013 to 2016. Results: The number of dermatologists within the Medicare system increased from 10,210 to 10,749. The proportion of prescriptions by dermatologists that were oral antibiotics increased from 10.0% to 10.7% (p = .023). The use of oral antibiotics increased 10.1% (2.9 claims per 1,000 beneficiaries) from 28.7 to 31.6 claims per 1,000 beneficiaries. There were more oral antibiotic prescriptions in the South than in other regions. Doxycycline was the most commonly prescribed antibiotic each year in all regions. Conclusions: Between 2013 and 2016, the number of oral antibiotics prescribed by dermatologists has increased among Medicare patients. Dermatologists must continue to reevaluate antibiotic prescription practices, particularly among the elderly population, in order to provide optimal care to patients.