Healthcare access, satisfaction, and health-related quality of life among children and adults with rare diseases

Abstract

Background: Research in a variety of countries indicates that healthcare access and health-related quality of life are challenged among people with a variety of rare diseases (RDs). However, there has been little systematic research on the experiences of children and adults with RDs in the American healthcare system that identifies commonalities across RDs. This research aimed to: (1) Describe demographics, disease characteristics, diagnostic experiences, access to healthcare, knowledge about RDs, support from healthcare professionals, and patient satisfaction among people with RDs and their caregivers; (2) examine predictors of patient satisfaction among adults with RDs; (3) compare health-related quality of life and stigma to US population norms; 4) examine predictors of anxiety and depression among adults and children with RDs.

Results: This large-scale survey included (n = 1128) adults with RD or parents or caregivers of children with RDs representing 344 different RDs. About one third of participants waited four or more years for a diagnosis and misdiagnosis was common. A subset of participants reported experiencing insurance-related delays or denials for tests, treatments, specialists, or services. Approximately half of participants felt their medical and social support was sufficient, yet less than a third had sufficient dental and psychological support. Patients were generally neither satisfied or dissatisfied with their healthcare providers. Major predictors of satisfaction were lower stigma, lower anxiety, shorter diagnostic odyssey, greater physical function, and less pain interference. Adults and children with RDs had significantly poorer health-related quality of life and stigma in all domains compared to US norms. Predictors of both anxiety and depression were greater stigma/poor peer relationships, fatigue, sleep disturbance, limited ability to participate in social roles, and unstable disease course.

Conclusions: People in the U.S. with RDs have poor health-related quality of life and high stigma. These factors are related to patient satisfaction and healthcare access, including diagnostic delays and misdiagnosis. Advocacy work is needed in order to improve healthcare access and ultimately health-related quality of life for children and adults with RDs.

Keywords: Anxiety; Depression; Health-related quality of life; Patient satisfaction; Rare disease; Stigma.

Fig. 1

Self-reported time to get a confirmed diagnosis after seeking medical help

Fig. 2

Participants’ ratings of providers’ knowledge of rare disease and willingness to seek support during diagnosis

Fig. 3

Self-reported out-of-pocket expenses for health claims in 2019 (USD)

Fig. 4

Experiences with US health insurance approvals, delays, and denials for RD tests, medications, treatments, and services

Fig. 5

Perceptions of how well different provider types offered sufficient information about participants’ condition(s)

Fig. 6

Perceptions of how well different provider types offered sufficient care for participants’ condition(s)

Fig. 7

Participants’ perceptions of receiving sufficient types of support at diagnosis

Fig. 8

Participants’ experiences of different barriers to healthcare access