Prevalence and Associations of General Practice Registrars’ Management of Impetigo: A Cross-Sectional Analysis From the Registrar Clinical Encounters in Training (ReCEnT) Study

Hilary Gorges; Clare Heal; Mieke  van Driel; Amanda Tapley; Joshua Davis; Andrew Davey; Elizabeth Holliday; Jean Ball; Nashwa  Najib; Neil Spike; Kristen Fitzgerald; Parker Magin

doi:10.5826/dpc.1002a43

Prevalence and Associations of General Practice Registrars’ Management of Impetigo: A Cross-Sectional Analysis From the Registrar Clinical Encounters in Training (ReCEnT) Study

Authors

Hilary Gorges Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, Australia
Clare Heal Mackay Clinical School, College of Medicine and Dentistry, James Cook University, Mackay, Australia
Mieke van Driel Primary Care & General Practice, Faculty of Medicine, University of Queensland, Australia
Amanda Tapley GP Synergy, Australia
Joshua Davis Global and Tropical Health Division, Menzies School of Health Research School of Medicine, Darwin, Australia
Andrew Davey GP Synergy, Australia
Elizabeth Holliday Biostatistics, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
Jean Ball Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambston Heights, Australia
Nashwa Najib GP Synergy, Australia
Neil Spike Department of General Practice, The University of Melbourne, Notting Hill, Australia
Kristen Fitzgerald General Practice Training Tasmania
Parker Magin GP Synergy, Australia

Keywords:

impetigo, prevalence, bacterial, primary care, skin infection

Abstract

Background: Impetigo is a mild bacterial skin infection of childhood that is usually managed empirically in primary care.

Objective: To establish the prevalence and associations of impetigo in general practice (GP) registrars’ consultations.

Methods: Cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study data.

Results: Impetigo was managed in 0.24% of problems and 0.43% of consultations. Patient variables associated with impetigo presentations were younger age and impetigo as a new problem, while patients with non–English-speaking backgrounds were less likely to present with impetigo. Associated registrar variables were being new to the registrar and practicing in outer regional/remote locations. Compared with all other problems/diagnoses, impetigo more often involved information seeking, ordering pathology, and prescription of medication, but less often involved follow-up or referral.

Conclusions: Impetigo accounts for 0.43 per 100 GP registrar consultations in Australia. Association with outer regional/remote areas may reflect climate and socioeconomic factors that predispose to impetigo. Associated pathology requests may reflect a lack of confidence in GP registrars’ management of impetigo. Cultural differences may exist regarding health-seeking behavior relating to impetigo.

References

Sladden MJ, Johnston GA. Common skin infections in children. BMJ. 2004;329(7457):95-99.

Bowen AC, Mahe A, Hay RJ, et al. The global epidemiology of impetigo: a systematic review of the population prevalence of impetigo and pyoderma. PLoS One. 2015;10(8):e0136789.

WHO. Epidemiology and management of common skin diseases in children in developing countries. http://www.who.int/maternal_child_adolescent/documents/fch_cah_05_12/en/. Published 2005. Accessed August 2, 2018.

Shallcross LJ, Petersen I, Rosenthal J, Johnson AM, Freemantle N, Hayward AC. Use of primary care data for detecting impetigo trends, United Kingdom, 1995-2010. Emerg Infect Dis. 2013;19(10):1646-1648.

Bowen A. The Australian Healthy Skin Consortium. National Healthy Skin Guideline: for the Prevention, Treatment and Public Health Control of Impetigo, Scabies, Crusted Scabies and Tinea for Indigenous Populations and Communities in Australia. https://rhdaction.org/resources/national-healthy-skin-guideline-prevention-treatment-and-public-health-control-impetigo. Published 2018. Accessed August 2, 2018.

eTG. electronic Therapeutic Guidelines complete: Impetigo. https://tgldcdp.tg.org.au/viewTopic?topicfile=skin-soft-tissue-infections-bacterial&guidelineName=Antibiotic#toc_d1e1116. Published 2018. Accessed August 2, 2018.

Heal C, Gorges H, van Driel ML, et al. Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP’s management of impetigo. BMJ Open. 2019;9(10):e031527.

Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2015-16. http://purl.library.usyd.edu.au/sup/9781743325131. Published 2015-2016. Accessed October 24, 2018.

Whiting G, Magin P, Morgan S, et al. General practice trainees' clinical experience of dermatology indicates a need for improved education: a cross-sectional analysis from the Registrar Clinical Encounters in Training Study. Australas J Dermatol. 2017;58(4):e199-e206.

Morgan S, Magin PJ, Henderson KM, et al. Study protocol: the Registrar Clinical Encounters in Training (ReCEnT) study. BMC Fam Pract. 2012;13:50.

Britt H. A new coding tool for computerised clinical systems in primary care—ICPC plus. Aust Fam Physician. 1997;26(Suppl 2):S79-S82.

Australian Bureau of Statistics. 1216.0—Australian Standard Geographical Classification (ASGC), 2006. http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/1AE106C101420508CA2571A900170741. Published July 2006. Accessed August 2, 2018.

Australian Bureau of Statistics. 2039.0—Information Paper: An Introduction to Socio-Economic Indexes of Areas (SEIFA), 2006. http://www.abs.gov.au/ausstats/[email protected]/mf/2039.0/. Published 2006. Accessed August 2, 2018.

Thomas DP, Heller RF, Hunt JM. Clinical consultations in an aboriginal community-controlled health service: a comparison with general practice. Aust N Z J Public Health. 1998;22(1):86-91.

Loadsman MEN, Verheij TJ, van der Velden AW. Impetigo incidence and treatment: a retrospective study of Dutch routine primary care data. Fam Pract. 2019;36(4):410-416.

Nicolle LE, Postl B, Urias B, Law B, Ling N. Group A streptococcal pharyngeal carriage, pharyngitis, and impetigo in two northern Canadian native communities. Clin Invest Med. 1990;13(3):99-106.

Furue M, Yamazaki S, Jimbow K, et al. Prevalence of dermatological disorders in Japan: a nationwide, cross-sectional, seasonal, multicenter, hospital-based study. J Dermatol. 2011;38(4):310-320.

Romani L, Steer AC, Whitfeld MJ, Kaldor JM. Prevalence of scabies and impetigo worldwide: a systematic review. Lancet Infect Dis. 2015;15(8):960-967.

Peel MC, Finlayson BL, McMahon TA. Updated world map of the Köppen-Geiger climate classification. Hydrol Earth Syst Sci. 2007;11(5):1633-1644.

Simon M, Henderson K, Tapley A, et al. Problems managed by Australian general practice trainees: results from the ReCenT (Registrar Clinical Encounters in Training) study. Educ Prim Care. 2014;25(3):140-148.

Freed GL, Spike N, Magin P, Morgan S, Fitzgerald M, Brooks P. The paediatric clinical experiences of general practice registrars. Aust Fam Physician. 2012;41(7):529-533.

Bonney A, Phillipson L, Reis S, Jones SC, Iverson D. Patients' attitudes to general practice registrars: a review of the literature. Educ Prim Care. 2009;20(5):371-378.

Australian Bureau of Statistics. 2016 Census: Multicultural. http://www.abs.gov.au/ausstats/[email protected]/lookup/Media%20Release3. Published 2016. Accessed October 31, 2018.