GPs' practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care

Background Isotretinoin is prescribed in secondary care for severe acne vulgar's. Anecdotal reports suggest that GPs in Ireland currently initiate isotretinoin. Aim To ascertain the prevalence and management of isotretinoin in Irish general practice and to describe GPs attitudes about the use of isotretinoin in Ireland. Design and setting A cuss-sect tonal questionnaire survey of GPs in Ireland between October 2018 and February 2019. Method Two short questionnaires were developed; one for GPs who prescribe isotretinoin and one for GPs who do not prescribe isotretinoin. Questionnaires were distributed via email and online via GP Forum to GPs in Ireland. Results Of a total 298 GPs who completed the questionnaire. 52 (17%) initiated isotretinoin. Older GPs (aged >= 35 years) and male GPs were more likely to prescribe isotretinoin. GPs cited prolonged dermatology waiting lists (n = 34, 65%) and a special interest in dermatology In = 31, 60%I as two key drivers to initiating isotretinoin. However, this study found evidence of suboptimal blood monitoring, pregnancy testing, and contraceptive advice. Most GPs (n = 244, 83%) did not initiate isotretinoin and identified multiple barriers; medicolegal concerns (n= 150, 61%), being unaware that GPs may initiate isotretinoin (n = 135, 55%). and being unfamiliar with managing isotretinoin (n = 102, 41%). Important enablers to initiating isotretinoin cited by GPs include Irish College of General Practitioners guidelines (n=118, 48%) and dermatologist support (n = 119, 48%). Two-thirds of the GPs questioned (n = 164, 67%) expressed an interest in initiating isotretinoin and most (n = 223, 91%) agreed that GPs can safely manage isotretinoin. Conclusion Few GPs in Ireland currently initiate treatment of acne with isotretinoin. and there is suboptimal adherence to recommended monitoring. Barriers to and enablers for GPs initiating isotretinoin were identified. Most GPs expressed an interest in initiating isotretinoin.