Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection

Lipworth, Adam D.; Park, Jong Min; Trefrey, Brie L.; Rubin, Krista M.; Geller, Alan C.; Sober, Arthur J.

doi:10.1016/j.jaad.2010.08.021

Cited by 14 publications

(10 citation statements)

References 25 publications

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“…The meta-narrative plot of the lead-up to diagnosis additionally comprises generic issues regarding patients’ lack of control over wait times for appointments. We identified wait times of 6 weeks to 4 months, which is at the benchmark of other research on wait times for specialist consultations (see, for example, Cheng, Moreau, McGuire, Ho, & Ferris, 2014; Lipworth et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

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When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients’ Journeys in Four Countries

Lamprell

Braithwaite

2017

Qual Health Res

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Malignant melanoma is an aggressive, recalcitrant disease. Its impact on people can be compounded by the physical and psychosocial consequences of medical management. Providing melanoma patients with patient-centered care that is effective, safe, and supportive throughout their journey requires knowledge of patients' progressive experiences and evolving perspectives. With ethical approval, we undertook a meta-narrative study of 214 experiential accounts of melanoma collected from the personal story sections of melanoma and cancer support websites. Using a narrative approach, we qualitatively examined the care experiences represented in these accounts and identified needs for supportive care in a framework reflective of the personal patient journey. We differentiate these across three key periods: lead-up to diagnosis; diagnosis, treatment, and recovery; and posttreatment and recurrence, and provide a visual representation of the patient journey. This article contributes to the growing body of work that utilizes Internet content as sources of qualitative, experiential health care data.

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Section: Discussionmentioning

confidence: 99%

“…This may be compounded by a lack of clinical awareness about correct biopsy procedures (Scolyer, Vilain, & Mihm, 2016). As a result, diagnosis and treatment can be ill-defined, protracted, and complex experiences (Lipworth et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients’ Journeys in Four Countries

Lamprell

Braithwaite

2017

Qual Health Res

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“…With the rise in incidence of skin cancer and growing demandsupply gap due to the suboptimal number of dermatologists, appropriate triage of dermatologic lesions is essential to ensure prompt care of high-risk patients [25,26]. Tsang et al found that patients with a changing mole waited an average of 38 days prior to evaluation [27].…”

Section: Triagementioning

confidence: 99%

Error Avoidance in Dermatologic Surgery

Decker

Lawrence

2015

Curr Derm Rep

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Surgical errors pose a significant source of morbidity, mortality, and expense within the health care system. While rates of errors within dermatologic surgery are low, there are certain areas of dermatologic surgery that are more prone to errors than others. These include site identification, specimen labeling, triage, lidocaine toxicity, needle sticks, electrosurgery, and laser surgery. Within these areas, continued research is being done to identify the source of the errors and establish protocols to minimize the risk.

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“…Unequal geographical distribution and inadequate supply of dermatology care providers are two contributors to long care delays. Although the number of US dermatologists per capita has nearly doubled over the past three decades (Resneck & Kimball, 2004), only 10% practice in rural areas despite over 55% considering this ratio insufficient to meet demand (Ehrlich et al., 2017; Lipworth et al., 2011; Moreau et al., 2014; Resneck & Kimball, 2008; Uhlenhake et al., 2009). While the dermatology literature is replete with descriptions of at‐risk populations (Alghothani et al., 2012; Chaudhry et al., 2013; Dorner et al., 2015; Eide et al., 2009; Guy et al., 2015; Lasithiotakis et al., 2008; Linos et al., 2009; National Cancer Institute, 2019; Pollack et al., 2011; Resneck et al., 2006), no studies have comprehensively examined access barriers that contribute to long appointment delays, particularly in underserved rural geographic regions.…”

Section: Introductionmentioning

confidence: 99%

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

Cyr

Boucher²,

Korona

et al. 2020

Journal of Advanced Nursing

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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.

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Urgent access to a specialty care melanoma clinic is associated with a higher rate of melanoma detection

Cited by 14 publications

References 25 publications

When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients’ Journeys in Four Countries

When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients’ Journeys in Four Countries

Error Avoidance in Dermatologic Surgery

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

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