Outpatient dermatology appointment wait times for United States military veterans, 2014-2021

Abstract

Trends in outpatient dermatology appointment wait times for United States (US) veterans are poorly characterized. Given concerns surrounding prolonged wait times at Veterans Health Administration (VHA) medical facilities, the federal government introduced the Maintaining Internal Systems and Strengthening Outside Networks (MISSION) Act in 2018, allowing veterans to receive VHA-reimbursed community care if VHA specialty care appointments cannot be scheduled within 28 days. Considering this expanded access to community care, we characterized among US veterans the (1) overall demand for dermatology appointments, (2) trends in average wait times, and (3) facility/geographic variation in wait times. The VHA Corporate Data Warehouse was queried for all dermatology appointments from January 1, 2014 to June 30, 2021. Appointment wait time, defined as time from appointment request to completion, was calculated for each care setting: VHA, community, and overall. Linear regression was used to assess average annual changes in wait times, and t-tests were used to compare mean wait times before and after the MISSION Act's implementation in 2018. Median wait times for each facility and state, and the proportion in each category meeting the MISSION Act goal wait time < 28 days, were determined using 2021 data. Our analytic cohort comprised 1,613,262 dermatology appointments directed through 130 VHA facilities. There was a 356% increase in demand for dermatology appointments from 2014 to 2019 (from 85,593 to 296,140 overall visits), with a corresponding 435% increase in demand for community appointments from 2014 to 2020 (from 11.7 to 50.9% of annual visits). Overall appointment wait times increased by an average 0.88 days annually, with community wait times increasing by an annual average of 1.09 days and VHA wait times decreasing by an annual average of 1.01 days (all P < 0.001). In 2021, 35% of VHA facilities and 20% of states had a median appointment wait time < 28 days. We observed an increase in demand over time for outpatient dermatology appointments among US veterans. Appointment wait times increased overall and in community settings, though decreased at VHA facilities. Understanding trends in appointment wait times will help refine policies aimed at increasing dermatologic care access for US veterans.

Keywords: Access to care; Dermatology; Health policy; Military; Veteran; Wait time.