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American Indian, Alaska Native groups face substantial barriers to dermatological care

Among American Indian and Alaska Native populations, various barriers to dermatological care exist including reasonable access to a dermatologist, geographic distance to the clinic and insurance coverage, according to a study in JAMA Dermatology.

“Given the lack of telehealth capacity to adequately meet dermatological need in many of these rural communities, one promising innovation involved the training and support of on-the-ground clinicians to expand their capacity to provide dermatological care,” Siobhan Wescott, MD, MPH, of the Indians Into Medicine program at the University of North Dakota School of Medicine and Health Sciences, and colleagues wrote.

Researchers created a cross-sectional telephone survey to determine geographic access and other barriers to dermatological services for American Indian patients living in rural communities.

Additionally, teledermatological programs were evaluated using a list of 38 active programs from the American Telemedicine Association.

The median distance from an Indian Health Service (IHS) or tribal hospital to the nearest dermatology clinic was 68 miles (interquartile range, 30-104), based on an open source mapping tool.

Twenty-one IHS or tribal hospitals (62%) did not have a dermatology clinic within a 35-mile driving radius and 11 hospitals (32%) lacked one within a 90-mile driving radius, the researchers wrote.

Twenty-seven rural brick-and-mortar clinics were closest to rural IHS or tribal hospitals (82.4 miles; interquartile range, 31-114) in 10 states.

Patients with Medicaid were accepted at 16 clinics (59%), and three clinics (11%) accepted patients with only certain forms of Medicaid or who were dual-eligible for Medicare and Medicaid. The researchers also reported that six clinics (22%) did not accept patients with Medicaid, and 17 clinics (63%) accepted those without insurance who could afford self-pay or a payment plan.

Patients referred through the IHS Purchased/Referred Care program were not accepted at six clinics (22%), whereas patients with IHS Purchased/Referred Care referrals were accepted at two clinics (7%) but did not accept Medicaid, according to the study.

The researchers could not identify a single dermatologist from the clinics who traveled to provide care at an IHS or tribal site.

Of 49 teledermatological programs contacted, 45 (92%) replied; of 10 (20%) non-IHS programs, six were currently partnering, two previously partnered, and two programs were setting up services with an IHS tribal site, the researchers wrote.

Based on 2017 data, 27% of American Indian and Alaska Native adults were covered by Medicaid along with 50% of children.

American Indian veterans indicated they were significantly more likely to delay care from lack of transportation compared with white veterans, according to the study.

Not all active teledermatological programs may have been identified, which represents a study limitation, according to the researchers. Additionally, the information on accepted insurance and referral types may be limited, and the survey did not measure patient-side access nor underlying factors in geographic areas. – by Abigail Sutton

Disclosures: Morenz reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.