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Fungal preparations sometimes skipped due to discomfort performing microscopy

Numerous barriers prevent the common use of fungal preparations in the dermatology setting, such as the belief that clinical diagnosis is sufficient and the lack of a required Clinical Laboratory Improvement Amendment certification, along with the notion that it is difficult to obtain, according to recent survey findings.

“Ultimately, many dermatologists felt that the cumbersome nature of obtaining CLIA certification affects patient care,” wrote Adam J. Friedman, MD, professor and interim chair of the department of dermatology at the George Washington School of Medicine and Health Sciences, and Emily C. Murphy, a research fellow in the department of dermatology at the George Washington School of Medicine and Health Sciences.

To examine dermatologists’ perceptions of fungal preparations and beliefs surrounding participation in Clinical Laboratory Improvement Amendment (CLIA) certification, Friedman and Murphy sent an email survey to 7,629 recipients of the Orlando Dermatology Aesthetic and Clinical Conference email list.

The survey was completed by 308 individuals (56.88% women; 55.76% aged 25 to 44 years). Most respondents (95.32%) held MD or DO licenses, with 47.48% in practice for more than 10 years and 44.24% in practice for 1 to 10 years.

When a fungal infection is suspected, 20.94% of the dermatologist responders report rarely/never performing a fungal preparation, 19.86% report sometimes and 59.21% report always/very often performing a preparation. The dermatologists said clinical diagnosis is adequate or that the preparations require too much time.

Respondents report not having CLIA certification (21.32%) due to a lengthy process and time involved or they did not know how to apply, according to Friedman and Murphy.

Of those with CLIA certification, 27.89% claimed it was very difficult or difficult to obtain or maintain (26.96%), and 27.82% reported that the certification was not worth performing preparations.

“Compared to providers who often perform preparations, more providers who only sometimes perform these tests reported they are unnecessary, whereas more providers who rarely/never perform these tests reported being uncomfortable with the process or that they lack microscopes or CLIA certification (P .0001),” Friedman and Murphy wrote.

Further, reasons for not performing fungal preparations differed by experience level as residents were more likely to be uncomfortable performing them and more likely to view them as unnecessary, according to Friedman and Murphy.

Additionally, more providers in nonacademic settings lacked microscopes or CLIA certification.

To improve these barriers in the common use of fungal preparations, education and support to aid in CLIA certification may help dermatologists navigate the requirements without excessive time and effort, according to Friedman and Murphy. – by Abigail Sutton

Disclosures: Friedman and Murphy report no relevant financial disclosures.