MedicalResearch.com Interview with:
Raghav Tripathi, MPH
Case Western Reserve University
MD Candidate, Class of 2021
MedicalResearch.com: Why did you decide to perform this study?
Response: Differences in the impact of dermatologic conditions on different groups have been of interest to our research group for a long time. Previously, our group had found differences in time to treatment for patients with different skin cancers. Beyond this, we had found differences in mortality and incidence of various skin conditions (controlling for other factors) in different racial groups/ethnicities, socioeconomic groups, demographic groups, and across the rural-urban continuum.
The goal of this study was to investigate socioeconomic and demographic differences in utilization of outpatient dermatologic care across the United States. As demographics throughout the country become more diverse, understanding differences in utilization of dermatologic care is integral to developing policy approaches to increasing access to care across the country.
MedicalResearch.com What would you like the public to know about your study?
Response: We found that substantial differences in sex, race/ethnicity, insurance status, region, and socioeconomic characteristics exist in use of dermatologic care in the United States. Specifically, Hispanic and black patients were less likely to receive outpatient dermatologic care than non-Hispanic white patients. Additionally, patients who were male, uninsured, Midwestern, insured by Medicaid/Medicare, or had a lower income or educational status were less likely to receive outpatient dermatologic care.
MedicalResearch.com: What was most surprising about your findings?
Response: Our most surprising finding was the magnitude of these differences, even after controlling for type of condition. For example, men had approximately 2/3 the odds of visiting a dermatologist for their condition compared to women, and black and Hispanic patients had approximately half the odds of visiting a dermatologist when compared to non-Hispanic white patients. The magnitude of these differences persisted when looking at differences in utilization in educational level, income, and insurance status.
Another very surprising aspect of our findings was the low rate of utilization of dermatologic care for patients with dermatologic conditions. Of all patients with dermatologic conditions, only 36.47% visited a dermatologist—the rate of utilization ranged from 10.57% for patients with chronic skin ulcers to 74.02% for non-melanoma skin cancers.
MedicalResearch.com: How might your findings improve patient care?
Response: Previous research has shown the importance of visiting a dermatologist for patients with skin conditions. The vast differences in utilization of dermatologic care between racial/ethnic groups and insurance groups is very important in informing policy interventions to improve healthcare for Americans. In a time of contentious healthcare reform, we hope that our findings will help clinicians engage with policymakers to develop ways to remove barriers to utilization of dermatologic care for all Americans with skin conditions.
Similarly, we hope that these findings will encourage hospitals and dermatology clinics to consider quality improvement measures to improve utilization of dermatologic care among patients. These might include interventions for multicultural and minority-specific care, such as having an on-site translator, financial counselor, modifying resources in clinic to improve patient education and health literacy, and increasing outreach in rural areas of the country.
MedicalResearch.com: What else is important to include?
Response: Access to dermatologists is a critical component of comprehensive care for patients with skin conditions. Differences in utilization of outpatient dermatologists may be a key predictor for increased mortality and detriment to quality of life in different sociodemographic groups. We hope that this research will spur further work in better understanding the reasons for these differences and utilizing population-based targeted interventions to improve the overall health of Americans.
Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States. JAMA Dermatol. Published online September 26, 2018. doi:10.1001/jamadermatol.2018.3114
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