PSD05 Establishing a tertiary male genital clinic: lessons from 1 year of clinical practice

Abstract

Men with genital dermatoses wait long periods of time before seeing a specialist – often due to poor accessibility to specialist clinics. We established a male genital service that allowed general practitioners (GPs) to book directly into clinic. After 1 year, we audited the service to see whether the resource was being used appropriately and how it could be optimized. We evaluated referral patterns and appropriateness, waiting times, investigation practices and clinical outcomes in our specialist male genital dermatology clinic. A retrospective audit was conducted of all patients booked into a male genital dermatology clinic over a 12-month period. Data collected included demographics, referral source and reason, did not attend rates, time from referral and appropriateness of referral, diagnostic outcomes, discharge, and follow-up arrangements. In total, 59 appointments were reviewed, including 51 new patients and 8 follow-up patients. The mean patient age was 41.4 years. Among new referrals, 63% originated from GPs, 27% from dermatology and the remainder from urology and genitourinary medicine. The median time from referral to appointment for new patients was 66 days (range 15–501), increasing to 92 days for GP referrals. Overall, 73% of new referrals were deemed appropriate, although appropriateness among GP referrals (60%) was lower than for other specialties (94%). The most common reason for referral was suspected lichen sclerosus (n = 15). The overall did-not-attend rate was 17%, but it was higher for new GP referrals (20%) than for other specialties (11%). All 43 patients who attended clinic received a diagnosis; biopsies were performed in 19%. Overall, 40% of new patients were discharged. Our male genital clinic provides accessible tertiary care with short waiting times. We report a high level of inappropriate referrals and a high did-not-attend rate, particularly from GP referrals. We have now moved to a triage system to optimize the use of the resource while maintaining accessibility.