In the United States, use of dermatologic care outpatient services varies widely across socioeconomic and demographic lines, indicating a need for changes that would improve the use of dermatologic care among disadvantaged populations, according to a study published in JAMA Dermatology.  

To illuminate differences in the use of outpatient dermatologic care services across the United States, researchers conducted a retrospective analysis of data from the nationally representative 2007 to 2015 Medical Expenditure Panel Survey (MEPS) from the Agency for Healthcare Research and Quality. Multivariable logistic regression analysis of the rates of office-based and outpatient dermatologist visits were used to examine health care use outcomes for dermatologic inflammatory conditions/ulcers, infections, skin cancers, and other skin disorders, while also accounting for age, sex, ethnicity/race, insurance status, income, education, region, and self-reported health status and condition.

Of the 183,054 MEPS respondents, 10.7% (n=19,561) self-reported a dermatologic condition, and 49.3% (n=9645) of those patients showed a total of 11,761 outpatient dermatologist visits. Black (adjusted odds ratio [aOR] 0.42; 95% CI, 0.38-0.46) and Hispanic (aOR 0.55; 95% CI, 0.49-0.61) respondents were both less likely to receive dermatologic outpatient services for their conditions than non-Hispanic white respondents. 

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Midwestern respondents were less likely to receive dermatologic care services than Northeastern respondents (aOR 0.80; 95% CI, 0.70-0.91), and men were less likely to receive dermatologic care services than women (aOR 0.66; 95% CI, 0.62-0.70). Uninsured patients and patients with Medicare or Medicaid coverage (aOR 0.39; 95% CI, 0.33-0.47 and aOR 0.75; 95% CI, 0.68-0.83, respectively) were also less likely to receive outpatient dermatologic services. Odds of receiving outpatient care services for a dermatologic condition increased with income and educational level.

Study investigators concluded that the findingsindicate an urgent need to characterize these differences further to improve rates of outpatient dermatologic care use in disadvantaged populations, noting that “[i]t is critical for dermatologists to engage policy makers regarding targeted interventions based on public and population health to improve access to and use of outpatient dermatologic care. Dermatologists should also encourage initiatives to increase access to multicultural care and minority-specific care, including improving patient education and health literacy.”

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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 [published online September 26, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.3114