Addressing Social Determinants of Health Improves Dermatologic Care in Underserved Populations

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Rebecca Vasquez, MD, FAAD, associate professor in the department of dermatology at the University of Texas Southwestern Medical Center in Dallas, emphasized the critical role of addressing social determinants of health to reduce disparities in dermatology, particularly within underserved communities. She advocated for a more diverse dermatology workforce to enhance patient trust and improve outcomes.

Vasquez referenced a previous patient during the session she participated in, Bridging the Gap: Addressing the Social Determinants of Health to Decrease Health Disparities in Dermatology at this year’s American Academy of Dermatology annual conference where she touched on the significant impact of cultural background and socioeconomic status on patient perceptions of dermatological health. She highlighted patient willingness to seek care, citing the need for culturally relevant public education to raise awareness of skin conditions and encourage timely intervention.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

How do you address barriers to adherence, such as limited access to pharmacies, financial constraints, or language differences, that disproportionately affect underserved communities?

We deal with that, not infrequently. I work at a safety net hospital, and I would say that we work really hard to find affordable medications. Sometimes we're using GoodRx. Honestly, sometimes it's cheaper for them to get it that way than with their insurance. We try, if possible, to compound medication so they are more accessible to them. There are some medications that are FDA approved, but they're thousands of dollars, that we can get compounded for patients at a cheaper price.

We work with a lot of the patient-assistance programs. We work side by side with patients to get them approved. Patient-assistance programs, for example, biologics, are really important in treating psoriasis and eczema. We also know that some patients can't even get to the pharmacy. Where possible, we try to provide the medications through mail order. Those are some of the ways that we really work to advocate for our patients to get the therapies that they need.

How does the patient's lived experience, including their cultural background, socioeconomic status, and personal beliefs, influence their perception of dermatological health and their willingness to seek care?

I think that's a very important question when you talk about dermatology because I would say that some people think that accessing dermatology in some ways, is a privilege. You have to, sometimes, have access to a primary care doctor, and some people don't even have access to that. For me, I didn't even know what dermatologists did until I got to medical school. I also grew up without insurance, and so I always thought that the family doctor did everything.

I was just explaining a case, we had seen a patient, a Latina patient, who had come in for a nail change that was diagnosed as a melanoma, and she was shocked. She was completely shocked that that was a melanoma. She said she had never seen anybody that looks like her that has melanoma.

Unfortunately, it was so advanced she had to have an amputation, but then there were also the issues that come with mistrust, maybe just because you're not familiar with the health care system. She wasn't from here, so she wasn't familiar with it. I think that sometimes our perceptions of skin diseases are limited, just because we haven't seen anybody who's had it. It may make it more challenging to talk to patients about potential therapeutics.

If they think "Well, I've never seen anybody. How am I supposed to believe that this is what I have?" I think it can shape the patient's experience. I think what we need to do as a specialty is really do better about providing culturally relevant public education on skin conditions that affect these patients that maybe don't have access to us, that don't even realize that they're at risk for it, but provide that education as publicly as possible, so that they're aware that it is a possibility, and they're prepared when they see something, they're prepared to see someone about it, because they know that it can affect them as well.