A mixed methods analysis of access barriers to dermatology care in a rural state

Abstract

Aims To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability. Design Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi‐structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017–1 March 2018, and interviews and surveys were conducted between June 1–August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system. Methods Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi‐square tests for homogeneity to develop a unified understanding. Statistical modelling using odd‐ratio logistic and linear regression were performed for each outcome variable of interest. Results Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771; p = .007) and at nearby sites with limited availability (OR: 4.024; p = .024), but not at geographically further sites with higher capacities (p = .844). Referral under‐diagnosis occurred in 20.8% of those biopsied. Older (p = .041) or non‐working (p = .021) patients were more likely to remain unevaluated than seek more available but geographically further care. Conclusions In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at‐risk populations. Impact Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.

Barriers to healthcare access in pediatric dermatology: A systematic review

“…18,19 Meanwhile, geography has also been found to be a BtHA for patients seeking dermatologic care as there is a relative shortage of dermatologists in rural settings as compared to urban. 20 Resneck Jr et al ( 2004) 19 also noted that patients using Medicaid in certain geographic regions were more likely to be rejected when requesting an appointment, but no conclusions were drawn regarding the geographic trends of patient acceptance. A recent cross-sectional study by Ashrafzadeh et al (2020) also found a lack of pediatric dermatologists in rural United States, noting that some counties with more than 500 000 children did not have a local pediatric dermatologist.…”

DeepMetaForge: A Deep Vision-Transformer Metadata-Fusion Network for Automatic Skin Lesion Classification

“…These circumstances, causing the sheer influx of concerned patients, have posed bottleneck problems in many hospitals with insufficient dermatologists, causing hospital congestion that may lead to a decline in the quality of medical care [7]. Furthermore, studies have shown that patients who live far from major hospitals, particularly in rural regions or with poor incomes, identified long waits and long travel distances as barriers to receiving proper dermatologic care [8]. As a result, people in rural areas are more likely to disregard their health concerns until it is too late, owing to the expenses of communication and hospitalization, as well as their hectic routines [9,10].…”

Community Dermatology: Current Status and the Way Forward

“…A study from Maine, which is a predominantly rural state in USA, showed that the diagnostic accuracy of primary care providers is an important determinant of the outcome of dermatology care. [ 8 ] Community initiatives have been proven effective in several medical specialities such as psychiatry. There have been several reports about the relevance of community dermatology, including from developing countries.…”