Daniel Q. Bach, MD, MPH

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Insurance status, health disparities by race, and rurality showed substantial challenges to patients wishing to be evaluated by dermatologists, according to recent findings on the patterns and factors associated with receiving dermatologic care in the US.¹

These findings were the result of the National Ambulatory Medical Care Survey (NAMCS) which was conducted to identify these key predictors in pediatric patients with dermatologic conditions in the period between 2009 and 2015.²

This research into the statistics of pediatric patients was authored by Daniel Q. Bach, MD, MPH, from Cedars Sinai Dermatology in Los Angeles, California.

“This study aims to identify key predictors of outpatient dermatology care for pediatric patients by analyzing representative national data on pediatric outpatient visits to help guide educational initiatives, policy formation, and resource allocation to improve pediatric dermatologic care,” Bach and colleagues wrote.

Background and Findings

The investigators used data from the National Ambulatory Medical Care Survey (NAMCS), which is known to represent non-federal outpatient-based clinicians on a national level. The search focused on patients classified as pediatric (<18 years old) and diagnosed with dermatological conditions from 2009 - 2015.

Several elements, such as patients’ demographics (race, age, sex, insurance), appointment details (wait time and duration), mid level provider involvement, visit diagnoses, clinical characteristics, and referrals, were assessed by the research team. The team classified the term "dermatologists" as all dermatologic providers, including mid-level providers, while they determined "non-dermatologists" would encompass other providers who did not primarily offer dermatologic care.

The patients’ diagnoses were classified based upon evaluations by dermatologists and other providers such as general/family practice, pediatrics, and internal medicine. The study excluded adult patients (≥18 years) from the analysis.

The investigators noted that they identified the most frequent dermatologic diagnoses through the use of International Classification of Diseases, Ninth Revision, Clinical Modification codes. Statistical methods, such as student t-tests and chi-square tests, were also employed by the team to assess differences in demographic and clinical characteristics between patient visits which were evaluated by dermatologists and other providers.

Additionally, the investigators used multivariate logistic regression analysis to determine elements which influenced visit evaluations by dermatologists compared to providers from other types of specialties. Their study used survey weights within the NAMCS database to generate nationally representative estimates of the American population.

During the investigators’ study, a substantial number of pediatric patients, totaling 85,217,557 (survey-weighted), were observed by the team. Among the sampled patients, 29.3% were reported to have received evaluations from dermatologists, while 70.7% were reported to have been seen by non-dermatology providers.

The investigators noted that dermatologists were frequently diagnosed atopic dermatitis in children in the age range of 0-3 years, whereas non-dermatologists often were shown to have reported unspecified contact dermatitis among all age groups.

The study's multivariable logistic regression analysis demonstrated several key factors associated with a higher likelihood of being evaluated by a dermatologist, including age being of the Caucasian race, older than 1 year, residing in a metropolitan area, having private insurance rather than Medicaid, receiving a referral from another provider, and experiencing longer appointment wait times.

“Our findings call attention to the need for educators to create initiatives and implement strategies to close the gap in patient access to pediatric dermatologists,” they wrote. “These strategies may include integrating more urgent care/same-day visits in dermatology outpatient clinics. Telehealth appointments may also allow improved access to care in situations where dermatology care for pediatric patients is limited.”

References

1. ^{Noveir SD, Afifi L, Nguyen KA, Cheng CE, Bach DQ. Patterns and determinants of pediatric dermatologic care in the United States: An evaluation of the National Ambulatory Medical Care Survey from 2009 to 2015 [published online ahead of print, 2023 Jul 13]. Pediatr Dermatol. 2023;10.1111/pde.15387. doi:10.1111/pde.15387.}
2. ^{Schachner L, Ling NS, Press S. A statistical analysis of a pediatric der- matology clinic. Pediatr Dermatol. 1983;1(2):157-164. doi:10.1111/j. 1525-1470.1983.tb01108.x}