Background: Difficulty in patient access to care and affordability are major problems faced by our dermatology specialty in the United States.  However, Taiwan provides adequate and affordable dermatologic care for all of its citizens.  Herein we describe our first-hand observations and findings of the outpatient dermatology experience in Taipei, and contrast it to the experience in the United States.

Observation: In Taipei, Taiwan, we observed patient management, electronic documentation, and billing during outpatient dermatology visits in five settings: one academic hospital outpatient dermatology department, one academic hospital Information Technology department, and three private dermatologists’ offices. Through our observations, we found that the dermatology specialty in Taiwan is able to overcome challenges with access to care and affordability through three key system features: (1) short yet frequent patient visits (2) close proximity of ancillary staff, and (3) an integrated and paperless electronic medical record and billing system.

Conclusions: The Taiwan system is attained with some sacrifice, such as shorter time spent with patients and less personalized care. However,  because this system can meet the basic dermatological needs of the entire population, possibly better than our current system, it behooves us to study the Taiwan system with respect and care.

ImportanceThe dynamics of the medical care team, including interactions between physicians and nursing staff, has a large role to play in patient care, patient satisfaction, and future possible reimbursement determination. In order to implement changes to improve this dynamic within the medical team, it is imperative that appropriate assessments are completed to determine baseline satisfaction of our patients and nursing staff in addition to provider self-assessment.

ObjectiveWe aimed to investigate patient and nursing staff satisfaction with regards to provider quality of care in an outpatient academic dermatology clinic setting. We also sought out to determine provider insight in regards to satisfaction of patient and nursing staff.

MethodsOur nursing staff, patients, and providers completed a questionnaire. We then compared nursing satisfaction data and patient satisfaction data with provider self-assessment to determine provider self-awareness.

ResultsA total of 23 provider and nurse surveys and 562 patient satisfaction surveys were completed. Paired comparison and descriptive statistics were utilized to compare patient satisfaction, nursing satisfaction, and provider self-assessments.

ConclusionsOverall, the results of the surveys demonstrated that the nursing staff and patients had high satisfaction in their interactions with the dermatology physicians. The physicians had appropriate insight into how they were perceived by the nursing staff and patients. Attending physicians as compared to resident physicians and male physicians as compared to female physicians tended to underrate themselves.

Background: Rosacea and melasma are two common skin conditions in dermatology. Both conditions have a predilection for the centrofacial region where the sebaceous gland density is the highest. However it is not known if sebaceous function has an association with these conditions.

Aims and Objectives: We aimed to assess the relationship between facial glabellar wrinkle severity and facial sebum excretion rate for individuals with rosacea, melasma, both conditions, and in those with rhytides. Secondly, the purpose of this study was to utilize high resolution 3D facial modeling and measurement technology to obtain information regarding glabellar rhytid count and severity.

Materials and Methods: A total of 21 subjects participated in the study. Subjects were divided into four groups based on facial features: rosacea-only, melasma-only, rosacea and melasma, rhytides-only. A high resolution facial photograph was taken followed by measurement of facial sebum excretion rate (SER).

Results: The SER was found to decline with age and with the presence of melasma. The SER negatively correlated with increasing Wrinkle Severity Rating Scale. Through the use of 3D facial modeling and skin analysis technology, we found a positive correlation between clinically based grading scores and computer generated glabellar rhytid count and severity.

Conclusion: Continuing research with facial modeling and measurement systems will allow for development of more objective facial assessments. Future studies need to assess the role of technology in stratifying the severity and subtypes of rosacea and melasma. Furthermore, the role of sebaceous regulation may have important implications in photoaging.

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