INTRODUCTION
Disparities and inequities exist in dermatological access and outcomes, associated with demographics such as socioeconomic status (SES) and geography.1,2 Some studies have documented barriers to care and treatment adherence in dermatology such as financial and insurance challenges, logistical considerations, and sociocultural beliefs.1-3 There remains a need for further data on dermatology patient experiences in accessing care and treatment adherence. This study sought to evaluate the prevalence of and reasons for care avoidance and nonadherence.
An 11-question national cross-sectional survey study was disseminated in March 2021 to a random sample of 1595 out of 2.5 million Americans in the SurveyMonkey® Contribute and Rewards Panel (San Mateo, CA). The survey was piloted by Venkatesh et al in the George Washington University Medical Faculty Associates Dermatology Department.4 Of 1595 surveyed, 1525 completed the survey (96.3% response rate). One screening question was used: “Have you ever seen a dermatologist?” Of 1525 completed survey submissions, 1130 (74.1%) had seen a dermatologist before and continued to complete the survey. Of these participants, 9 were under 18 years and excluded, resulting in 1121 submissions for further analysis. Multivariate logistic models were used to calculate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of demographic variables. All analyses were performed using R (R Foundation for Statistical Computing, Vienna, Austria).
The demographic distribution of participants is shown in Table 1. More participants had private insurance, higher education, and higher SES than the general population. Of 1121 participants, 51.8% reported delaying or avoiding seeing a dermatologist about skin, hair, or nail problem. Common reasons for care avoidance included “Health insurance and/or financial challenges” (42.9%), “Logistical challenges (eg, long wait times, transportation, childcare, etc.)” (33.9%), “I felt safe/healthy and/ or had no symptoms” (23.9%), and “Distrust of physician” (16.0%). Demographics associated with higher care avoidance included younger age, female gender, $15,000-29,999 income range, and Medicare-insured (Table 2).
Additionally, of 1121 participants, 22.7% of patients reported nonadherence with dermatologist treatment recommendations. The most common reasons were side effects and adverse events (27.9%), expensive treatment cost (24.0%), treatment plan complexity and forgetfulness (14.7%), patient-provider disagreement or distrust (13.2%), and perceived lack of medication efficacy (9.3%). Demographics associated with higher nonadherence included younger age, lower income ranges, and Medicare-insured (Table 2).
Our study found that a majority (51.8%) of participants avoided or delayed dermatology care, larger than general healthcare estimates (20%-30%).5 Additionally, a significant minority (22.7%) of participants reported treatment nonadherence, lower than previous dermatology nonadherence estimates (34-45%).6
Financial and insurance challenges were the most commonly cited barrier to care (42.9%), and expensive treatment cost was the second most common barrier to adherence (24.0%). Correspondingly, patients with income of $15,000-29,999 and Medicare insurance had higher odds of care avoidance and nonadherence. Indeed, one national study found only 29.8% of surveyed dermatologists accepted public insurance and privately insured patients had shorter appointment wait times.8 Logistical challenges (33.9%) were also a significant barrier to care. Strategies to overcome financial and logistical barriers include teledermatology, accurate cost prediction, and facilitated access to safety net providers.3
Distrust was another significant reason for care avoidance (16.0%) and nonadherence (13.3%). Dermatologists should
An 11-question national cross-sectional survey study was disseminated in March 2021 to a random sample of 1595 out of 2.5 million Americans in the SurveyMonkey® Contribute and Rewards Panel (San Mateo, CA). The survey was piloted by Venkatesh et al in the George Washington University Medical Faculty Associates Dermatology Department.4 Of 1595 surveyed, 1525 completed the survey (96.3% response rate). One screening question was used: “Have you ever seen a dermatologist?” Of 1525 completed survey submissions, 1130 (74.1%) had seen a dermatologist before and continued to complete the survey. Of these participants, 9 were under 18 years and excluded, resulting in 1121 submissions for further analysis. Multivariate logistic models were used to calculate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) of demographic variables. All analyses were performed using R (R Foundation for Statistical Computing, Vienna, Austria).
The demographic distribution of participants is shown in Table 1. More participants had private insurance, higher education, and higher SES than the general population. Of 1121 participants, 51.8% reported delaying or avoiding seeing a dermatologist about skin, hair, or nail problem. Common reasons for care avoidance included “Health insurance and/or financial challenges” (42.9%), “Logistical challenges (eg, long wait times, transportation, childcare, etc.)” (33.9%), “I felt safe/healthy and/ or had no symptoms” (23.9%), and “Distrust of physician” (16.0%). Demographics associated with higher care avoidance included younger age, female gender, $15,000-29,999 income range, and Medicare-insured (Table 2).
Additionally, of 1121 participants, 22.7% of patients reported nonadherence with dermatologist treatment recommendations. The most common reasons were side effects and adverse events (27.9%), expensive treatment cost (24.0%), treatment plan complexity and forgetfulness (14.7%), patient-provider disagreement or distrust (13.2%), and perceived lack of medication efficacy (9.3%). Demographics associated with higher nonadherence included younger age, lower income ranges, and Medicare-insured (Table 2).
Our study found that a majority (51.8%) of participants avoided or delayed dermatology care, larger than general healthcare estimates (20%-30%).5 Additionally, a significant minority (22.7%) of participants reported treatment nonadherence, lower than previous dermatology nonadherence estimates (34-45%).6
Financial and insurance challenges were the most commonly cited barrier to care (42.9%), and expensive treatment cost was the second most common barrier to adherence (24.0%). Correspondingly, patients with income of $15,000-29,999 and Medicare insurance had higher odds of care avoidance and nonadherence. Indeed, one national study found only 29.8% of surveyed dermatologists accepted public insurance and privately insured patients had shorter appointment wait times.8 Logistical challenges (33.9%) were also a significant barrier to care. Strategies to overcome financial and logistical barriers include teledermatology, accurate cost prediction, and facilitated access to safety net providers.3
Distrust was another significant reason for care avoidance (16.0%) and nonadherence (13.3%). Dermatologists should
