Asian Patients With Psoriasis Receive Shortest Visits With Dermatologists

Asian patients with psoriasis have shorter visit durations with dermatologists than do patients of other races and ethnicities, according to a study published in JAMA Dermatology.

The difference in visit duration by race and ethnicity suggests potential disparities in care, although reasons for this difference are unclear.

The authors suggest that dermatologists have an obligation to provide each patient adequate time to address their concerns, develop strong communication, and build trust. Ineffective physician-patient communication can result in poor treatment adherence, comprehension, satisfaction, and outcomes for the patient.

Researchers performed a cross-sectional study to evaluate the association between a patient’s race and ethnicity and visit duration for psoriasis treatment with a dermatologist.

Data were collected from the National Ambulatory Medical Care Survey from 2010 through 2016 and analyzed in early 2022. In their analyses, researchers adjusted for age, sex, type of visit, visit complexity, insurance status, psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimen. Race and ethnicity were self-reported by patients.

Researchers identified a weighted estimate of 4,201,745 patient visits for psoriasis (95% CI, 3,688,629-4,714,862).

For demographic characteristics, a significant difference in age was found across the race/ethnicity groups (37.2 [95% CI, 32.0-42.4] years for Asian patients; 44.7 [95% CI, 33.4-56.0] years for Hispanic patients; 33.3 [95% CI, 16.9-49.7] years for Black patients; 54.8 [95% CI, 51.6-58.0] years for White patients; P = .001).

There was also a significant difference in the proportion receiving a complex topical regimen among groups (11.8% among Asian patients, 1.5% among Black patients, and 1.1% among White patients; P = .03).

Mean duration of visits was 9.2 minutes with Asian patients (95% CI, 4.4-14.1), 15.7 minutes with Hispanic or Latino patients (95% CI, 14.2-17.3), 20.7 minutes with non-Hispanic Black patients (95% CI, 14.5-26.9), and 15.4 minutes with non-Hispanic White patients (95% CI, 13.5-17.3).

Visits with Asian patients were found to have a 39.9% shorter mean duration compared with visits with White patients (β coefficient, −5.747 [95% CI, −11.026 to −0.469]; P = .03) and a 40.6% shorter mean duration compared with visits with non-Asian patients as a single group (β coefficient,−5.908 [95% CI, −11.147 to −0.669]; P = .03).

These findings suggest that Asian patients with psoriasis receive significantly less face-to-face time with a dermatologist compared with patients of other races and ethnicities, despite Asian patients tending to present with more severe psoriasis.

However, the etiology of these differences remains unclear, indicating a need for further research. The authors suggest that factors including unconscious bias, cultural differences in communication, or residual confounding might be responsible for the differences observed in these findings.

The authors encourage dermatologists to allow sufficient time to develop strong physician-patient communication regardless of patient background.

The study had limitations. Visit duration was self-reported by the physician or their staff—a method that has been studied in other fields, but formal validation studies are pending.

Researchers imputed missing data on race and ethnicity. They note that it is possible that patients who did not report race and ethnicity may have different characteristics affecting visit duration compared with those who did report this information.

Reference

Wu KK, Armstrong AW. Differences in face-to-face time spent with a dermatologist among patients with psoriasis based on race and ethnicity. JAMA Dermatol. Published online August 3, 2022. doi:10.1001/jamadermatol.2022.2426.