Research Suggests Hidradenitis Suppurativa Patients Rarely Seen by Dermatologists After Emergency Department

Cynthia Wang, MD, MPHS

A recent cohort study suggests that hidradenitis suppurativa (HS) patients who have visited the emergency department (ED) do not usually visit the dermatology clinic for ongoing care, highlighting the need for cross-specialty intervention.

Patients with the debilitating skin disease have been shown to primarily use high-cost and acute care settings, compared to those with other chronic skin conditions like psoriasis. HS patients’ dependence on non-ambulatory care may result in increased costs to both the patient and the health care system, and a lack of regular dermatology follow-up may lead to delays in optimal care.

There is evidence that delays like these can be associated with worsened outcomes in HS, such as increased Hurley stage and decreased response to treatment. It is for this reason that the study’s investigators, led by Cynthia X. Wang, MD, MPHS, of Washington University’s Division of Dermatology, found the topic to be of interest.

“Ultimately, although it has been demonstrated that patients with HS have high ED utilization for their disease and relatively low outpatient utilization, it is unclear what ED interventions and patient characteristics may be associated with these outcomes,” Wang and colleagues wrote. “The primary purpose of this cohort study was to investigate, in patients with HS who have an index ED visit for their disease, which interventions and patient characteristics were associated with ED return and dermatology follow-up within 30 and 180 days.”

Background

The cohort study was crafted from patients who had reported 2 or more HS claims for the study period of 2010 to 2019 and also had had a minimum of 1 ED visit for HS or a defined proxy. The research team’s data was analyzed from November 2021 to May 2022.

The investigators’ primary outcomes were returns to the ED or dermatology outpatient follow-up for HS or related proxy within a span of either 30 or 180 days of index ED trips.

The study included 20,269 HS patients (median [IQR] age, 32 [25-41] years) with 16,804 female patients. Of these 20,269 patients, 36.8% (7455) reported having commercial insurance and 63.2% (12,814) reported having Medicaid.

Findings

The investigators found that 17.2% (3484) of HS patients had at least 1 returning ED trip for their condition or proxy within the span of 30 days, compared to 2.4% (483) who had a dermatology visit (P < .001).

They also found that 34.0% (6893) patients reported a return ED visit for their condition or proxy within 180 days, compared to 6.8% (1374) with a dermatology visit (P < .001). Additionally, the investigators found that HS patients with Medicaid and patients with opioid prescriptions were more likely to return to EDs for treatment of their condition and less likely to have dermatology follow-up.

“This cohort study suggests that many patients with HS frequent the ED for their disease but are not subsequently seen in the dermatology clinic for ongoing care,” they wrote. “The findings in this study raise the opportunity for cross-specialty interventions that could be implemented to better connect patients with HS to longitudinal care.”

This study, “Factors Associated With Dermatologic Follow-up vs Emergency Department Return in Patients With Hidradenitis Suppurativa After an Initial Emergency Department Visit,” was published online in JAMA Dermatology.