Assessing General Practitioners' Confidence in Undertaking Assessment and Ongoing Management of Patients With Diagnosed, Stable Vulval Lichen Sclerosus (VLS): Laying the Foundation for a Shared-Care Model.

BACKGROUND: Vulval Lichen Sclerosus (VLS) is a chronic inflammatory condition requiring lifelong management to prevent severe complications including malignancy. A shared care model between general practitioners (GPs) and public non-GP specialists (dermatologist or gynaecologist) for patients with stable LS would alleviate the demand on public vulval services. This study aims to assess GPs' level of comfort in performing vulval examinations for patients with VLS which would underpin the feasibility of shared care. It also explores GPs' level of confidence in vulval health, preferences for future vulval training and perspectives on rapid access pathways which would enable a successful shared care approach.

METHOD: Online survey invitations were sent to GPs across South Australia via email, GP social media groups and health network newsletters between October and December 2024. Survey questions focused on GPs' prior training, confidence in assessing LS, preferences for additional training and referral pathways. Descriptive statistics were used to describe survey responses while Chi-squared and Fisher's exact test statistical methods were used to identify associations between explanatory variables and outcome variables. Additional binary logistic regression analysis was used to model odds ratios, confidence intervals and corresponding p-values for associations between the dependent and independent variables.

RESULTS: A total of 132 complete responses were received. 74% of GPs were comfortable undertaking vulval examinations for patients with VLS while 26% were not. Stage of training, scope of practice and previous additional training in women's health had statistically significant associations (p < 0.05) with this outcome. Detecting malignancy and performing vulval biopsy were skills with lower reported levels of confidence. Most GPs desired future upskilling in vulval health, particularly in the form of specialist led face-to-face and webinar-based education, while the most preferred rapid access pathway was an e-referral (or email) with a phone call to the specialty registrar as needed. If additional training, resources and rapid access pathways were provided, most GPs (91%) were inclined to participate in shared care.

CONCLUSION: Most GPs in this study were comfortable in undertaking vulval examinations for patients with VLS and expressed an inclination to participate in shared care. Further efforts are required to provide GPs with additional training and rapid access pathways for specialist input to facilitate a safe and effective shared care model.