Dermatological Needs in an Urban Free Health Care Setting

Abstract

Introduction A large proportion of the United States' underinsured population relies on free health clinics for their health care needs. With only a few free health clinics nationwide hosting specialty clinics, a small subset of which are dermatology clinics, there is a dearth of information in the literature on which dermatological pathologies and treatment modalities are most common in this setting. The purpose of this study was to establish the most common dermatological conditions and treatments in the free health care setting as well as understand which facets of care need improvement. Methods A total of 57 patients with dermatological findings were identified at an urban student-run free health clinic in the southern United States in the past two years (2019-2021). Information reviewed for each patient included general demographics, chief complaint, medical/surgical history, treatments/procedures required for each visit, treatments/procedures available for each visit, referrals, and follow-up rate. Qualitative analysis was performed. Results The median age of the patients that presented with dermatological findings was 40 while the most common ethnicities were white (26.2%), Hispanic/Latino (28.6%), and black (28.6%). The most common chief complaints were rashes and cysts with a majority (63.2%) of these patients presenting to this particular clinic for the first time. Seven patients (12.3%) were unable to receive treatment due to expense, procedure unavailability, or an unknown reason. The most common treatment prescribed included a topical steroid. A majority (71.9%) of the patients were unable to follow up as scheduled. A majority of patients (81.2%) that were able to follow up were adherent to their prescribed medication. Conclusion Although dermatological conditions are plentiful in the free health care setting, the literature currently contains no information regarding this topic. This may be due to low patient follow-up rates and inadequately charted outcomes on often outdated electronic health records. In order to best care for dermatology patients in this setting, it is necessary to understand the barriers to care and available treatment options.

Keywords: dermatology; health services accessibility; healthcare disparities; medically uninsured; urban health services.

Figure 1. Demographics of patients who presented with a dermatology complaint. There was a total of 28 male and 29 female patients, with a majority of the patients with recorded demographics being Hispanic/Latino or Black. Fifteen patients had no documented ethnicity.

Figure 2. Chief Complaint and Past Dermatological Disease. A total of 18 patients encounters out of 61 had a recorded history of past dermatological diseases.

Figure 3. Location of Dermatology Condition on the Body. Location of skin condition was recorded in a total of 58 patient encounters. In 15 cases, the condition was in two separate locations. In nine cases, the condition was in three or more locations.

Figure 4. Treatments Used at the Free Health Clinic for Dermatologic Conditions. A total of 40 patients out of 57 underwent treatment with medication only. Seven out of 42 patients received procedural treatment, which included injections, incisions, or biopsies. Two patients received both medication and procedural treatment.

Figure 5. Effectiveness of Treatment. A total of 16 patients out of 57 were able to follow up.

Figure 6. Recommendations for Establishing a Dermatology Clinic in the Free Healthcare Setting based on the Experience of the Studied Clinic