Mapping Barriers to Dermatology Care for Rural American Indian Communities

Abstract

Purpose: Understanding barriers to care from distance needed to travel to insurance coverage is an important step to creating high-quality, accessible health care systems, particularly for patients living in rural areas. Barriers to dermatology care for American Indian (AI) populations have not been studied extensively. Our purpose was to investigate barriers to dermatology services for AI patients in rural areas in terms of geography and insurance coverage, and to evaluate the current availability of teledermatology programs for Indian Health Service (IHS) and tribal hospitals and health centers. Methods: We conducted a mixed-methods study including a geographic analysis and a cross-sectional telephone survey with brick-and-mortar dermatology clinics and teledermatology programs based in the continental United States. Brick-and-mortar clinics were selected based on proximity to a rural IHS or tribal hospital. Teledermatology providers were selected by membership in the American Telemedicine Association or identification by a respondent. In total, 76 dermatology providers were eligible, and 92% participated in the survey. Results: The average driving distance between rural IHS or tribal hospitals and the nearest dermatology clinic was 68 miles. Of the 25 brick-and-mortar dermatology clinics responding to the survey, 22% do not accept Medicaid, and 22% do not accept IHS referrals for patients without insurance. Of the 45 teledermatology programs responding, 29% were no longer active. Telehealth programs reported providing teledermatology services to 27 of the 303 IHS or tribal hospitals or health centers in the continental United States (9%). Conclusions: Significant geographic and insurance coverage barriers to dermatology care exist for rural American Indian communities. Teledermatology innovations are therefore an appealing intervention for this rural patient population, particularly programs that train and support the dermatology expertise of on- the-ground frontline clinicians.