American Indian people residing in rural communities face several geographic and insurance coverage barriers to dermatologic care, including living far from the nearest dermatology clinic and/or rural or tribal hospital, according to a study in JAMA Dermatology. A lack of clinics that accept patients with Medicaid or Indian Health Service (IHS) referrals for individuals without insurance also contributes to inadequate provision of healthcare for this population.
A cross-sectional telephone survey and geographic analysis were conducted with brick-and-mortar dermatology clinics (n=27) and teledermatology programs (n=49) within proximity to IHS and tribal hospitals in or near rural areas of the continental United States. The main outcomes included the mean driving distance from rural IHS or tribal hospital facilities to the nearest dermatology clinic, the number of dermatology clinics within a 35- or 90-mile radius of IHS or tribal hospitals, insurance and types of referrals accepted by dermatology clinics, and the number of teledermatology programs associated with IHS or tribal hospitals or centers.
According to respondents, the median driving distance between rural tribal hospitals or IHS and the closest dermatology clinic was 68 miles (interquartile range, 30 to 104). The median driving distance between the nearest brick-and-mortar dermatology clinic and rural IHS or tribal hospital was 82.4 miles (interquartile range, 31 to 114).
Approximately 22% (n=6) of respondents to the survey reported that they did not accept patients with Medicaid coverage. Additionally, 22% (n=6) said they did not accept IHS referrals. Almost one-third (29%) of teledermatology programs were no longer active at the time of the survey. Up to 20% (n=10) of teledermatology programs were either partnering (n=6), previously partnered (n=2), or were in the process of beginning services (n=2) with an IHS or tribal site. Of the 303 rural IHS or tribal facilities in the United States, only 9% were reported to offer teledermatology services.
Limitations of the study include its cross-sectional design and the lack of assessment of underlying factors affecting geographic barriers to care access.
The researchers concluded that “focused efforts to address geographic and financial barriers in addition to improving the capacity of frontline dermatological practitioners may help minimize the disparities in outcomes for dermatological diseases” in this population.
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Morenz AM, Wescott S, Mostaghimi A, Sequist TD, Tobey M. Evaluation of barriers to telehealth programs and dermatological care for American Indian individuals in rural communities [published online June 19, 2019]. JAMA Dermatol. doi:10.1001/jamadermatol.2019.0872