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HS treated in EDs not followed up in derm clinics, study finds


 

FROM JAMA DERMATOLOGY

Findings are not surprising

Christopher Sayed, MD, professor of dermatology at the University of North Carolina at Chapel Hill, said in an interview that the study results are expected. “Many patients have trouble establishing care with a dermatologist familiar with HS, so they seek more fragmented care at urgent cares and EDs,” he said.

Christopher Sayed, MD, professor of dermatology, University of North Carolina, Chapel Hill

Dr. Christopher Sayed

“Some dermatologists are not familiar with HS or don’t accept insurance such as Medicaid,” Dr. Sayed added. “Many emergency room providers may not recognize that medical therapy for HS has evolved in a way that makes referral to a dermatologist more essential than ever. They may tell patients there is nothing else to do but return to the ED for the next flare. “Emergency medicine and dermatology training programs need to educate providers about appropriate long-term HS management.”

In an interview, Robert Glatter, MD, an emergency medicine physician at Lenox Hill Hospital in New York and assistant professor of emergency medicine at Hofstra University, Hempstead, N.Y., said that the study describes a reality he and his colleagues know too well.

“The study gives a true snapshot of the disarray and inequality that exists for patients disproportionately affected by HS. Those who are African American and low income suffer from lack of HS primary dermatologic care and follow-up at much higher rates than do other demographic groups,” he said.

Doctors would like to see the current situation change, Dr. Glatter noted. “It’s frustrating for emergency physicians and for dermatologists, who know that optimal follow-up care for this chronic and disabling disease should be with a dermatologist (and other surgical specialists if necessary).

“It’s a broken system. Patients can’t get appointments in nonacademic private settings because the bulk of dermatologists will not accept Medicaid. And many academic practices will not see these patients, either,” he commented. “We end up becoming a safety net of care.”

Replace the broken system with an integrated process

A solution to address the problem would be to set up follow-up dermatology appointments when patients arrive in EDs during and after normal business hours, Dr. Glatter suggested. “Developing a coordinated, structured, streamlined process requires buy-in from all stakeholders, including private dermatologists, academic dermatology clinics, and the government.”

Robert Glatter, MD, emergency medicine physician at Lenox Hill Hospital in New York City and assistant professor of emergency medicine at the Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York

Dr. Robert Glatter

Having the Centers for Medicare & Medicaid Services study interventions for high utilizers of EDs for HS would also help with “the development of economic and logistical changes, including provider reimbursement and allocation of funds to address this ongoing disparity in care,” he added.

Ideally, larger health care systems could collaborate with academic and nonacademic dermatologists to design a referral network that cares for all uninsured or underinsured patients, he said. “Balancing patient care and improved outcomes – while working on a framework for reimbursement – would be in everyone’s best interest.”

The study was partially funded by a grant from the National Center for Advancing Translational Sciences of the National Institutes of Health. One author reported financial involvements with multiple pharmaceutical companies. Dr. Wang, the remaining coauthors, as well as Dr. Sayed and Dr. Glatter reported no conflicts of interest with the study. Dr. Glatter is an editor and columnist at Medscape.

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