Written By Kevin Kerfoot / Reviewed By Ray Spotts
Board-certified dermatologist Jennifer Tan, MD, FAAD, is making critical skin care and hygiene items easily accessible to individuals experiencing homelessness during the COVID-19 pandemic. The American Academy of Dermatology (AAD) recently named her a Patient Care Hero, a program that recognizes physicians who transform patients' lives by using their expertise and collaborating with other physicians to treat serious skin disease.
“Patients experiencing homelessness are frequently exposed to harsh climate conditions without proper covering, resulting in skin-related diseases that range from common to life-threatening,” Tan said. “When COVID-19 began to spread, it was quickly apparent that our Boston Health Care for the Homeless Program (BHCHP) patients would not have the resources necessary to prevent disease and maintain hygiene.”
Prior to the pandemic, Tan and colleagues had begun to distribute skin care kits to help those experiencing homelessness manage acne, eczema, and dry skin in order to minimize discomfort and prevent infection. Homeless populations develop skin infections, traumatic injuries and inflammatory conditions more frequently than those with stable living conditions.
Approximately 20 percent of emergency department and community clinic visits by people who are homeless are to address skin problems.
As the state government issued COVID-19 stay-at-home guidance in late March, Dr. Tan and her colleagues at the Massachusetts General Hospital an BHCHP quickly realized those experiencing homelessness would face unique and difficult challenges during the pandemic, including lack of access to over-the-counter treatments and needed hygienic supplies.
They shifted program resources and assembled more than 1,000 COVID-19 care kits for people experiencing homelessness in Boston and Portland, Maine.
Understanding disparities in dermatology services
Findings describe disparities in the use of outpatient dermatology services. The odds of a black or Hispanic patient visiting an outpatient dermatologist are about half that of a white patient with the same skin condition, reports a recent study in JAMA Dermatology.
Recent policies under the Patient Protection and Affordable Care Act increased access to care for low-income and low-education individuals, but did not significantly improve disparities for specific ethnic groups or increase access to specialized care, like dermatology, for many demographics.
Patients most likely to receive outpatient dermatologic services in the study were white, educated women. The odds of a man seeking treatment for a dermatologic condition were about two-thirds that of a woman. Across all patients, service utilization increased proportionately with education level and income.
"Patients who were male, uninsured, Midwestern, insured by Medicaid/Medicare, or had a lower income or educational status were least likely to receive outpatient dermatologic care," says study first author Raghav Tripathi, MPH, a medical student at Case Western Reserve University School of Medicine.
"We hope our findings will encourage hospitals and dermatology clinics to consider their own quality improvement measures, designed to increase access to care among their patients. These could include interventions for minority-specific care, such as having an onsite translator, including a financial counselor in the appointment, or increasing outreach in rural areas."
The study includes nine years of data from 183,054 dermatology patients across the country. Researchers from Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center analyzed the data looking for demographic and socioeconomic patterns associated with use of dermatologic services.
Who is getting dermatologic care?
Patients may also benefit from interventions that target specific dermatologic conditions. Half of the patients in the study had a diagnosed dermatologic condition, yet only 36 percent of diagnosed patients sought care. Most patients diagnosed with a skin condition did not seek care at all during the nine-year study period.
"Differences in utilization of outpatient dermatologists may be a key predictor for increased mortality and detriment to quality of life in different groups," Tripathi added. "By understanding the reasons behind these differences through studies like ours, we can begin to develop population-based, targeted interventions."
The least likely to seek care were patients diagnosed with chronic skin ulcers - a common complication of diabetes and vascular disease. Nine out of 10 patients with chronic skin ulcers did not see a dermatologist during the study period.
Dermatologists can help recognize such ulcers and get patients into proper treatment. Without seeking care, patients may be unaware of the root causes of their skin conditions.
Patients most likely to seek care in the study were those diagnosed with non-melanoma skin cancers. Three out of four of these patients had at least one outpatient dermatologist visit during the study period. High service utilization in this population could prevent their non-melanoma lesions from turning more serious.
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With over 30 years of writing and editing experience for newspapers, magazines and corporate communications, Kevin Kerfoot writes about natural health, nutrition, skincare and oral hygiene for Trusted Health Products’ natural health blog and newsletters.
Founder Ray Spotts has a passion for all things natural and has made a life study of nature as it relates to health and well-being. Ray became a forerunner bringing products to market that are extraordinarily effective and free from potentially harmful chemicals and additives. For this reason Ray formed Trusted Health Products, a company you can trust for clean, effective, and healthy products. Ray is an organic gardener, likes fishing, hiking, and teaching and mentoring people to start new businesses. You can get his book for free, “How To Succeed In Business Based On God’s Word,” at www.rayspotts.com.