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Ensuring Equal Face-to-Face Provider-Interaction Time Among Patients


Amy McMichael, MD, discusses ways to ensure patients of all races and ethnicities are experiencing the same level of quality face-to-face interactions with their providers.

Ryan Haumschild, PharmD, MS, MBA: Dr McMichael, 1 thing we’ve seen in literature is that dermatologists are spending less face-to-face time [with their patients], specifically with Asian patients with psoriasis compared with patients of other races and ethnicities. Why do you think that is? How can we ensure that patients of all races and ethnicities experience the same level of quality face-to-face care that we expect from our provider? Is there any way that our payer colleagues can reinforce this?

Amy McMichael, MD: I was very interested in that article when it came out. We need to get in there and measure exactly what’s happening. Since we don’t have that opportunity, we can only guess that there would be potential barriers. What would those barriers be? It could be a language barrier. In our offices, we have an iPad that has around 50 or 60 languages, so we can call an interpreter and they can help us figure out what’s going on with this patient. What’s going on with their skin? We use those interpreters. It’s an intermediary in our interaction as a doctor and a patient. However, it tends to take longer because you have to have someone repeating everything that everyone in the room says. There’s probably a language barrier. There may be cultural barriers as well. You can’t generalize Asian culture, but there are cultures of people, who happen to be Asian, who don’t present everything they’re feeling and dealing with. [They must feel] it’s not acceptable to do so. You’re kept in the dark about some of the things that they may be experiencing, [including] adverse effects and complications. They may not be asking enough questions about how they should be utilizing their medication. There probably needs to be a couple of things that we advocate for, maybe an extra session where a nurse calls that patient in advance using an interpreter on the phone, and says, “What questions do you have for the doctor? We want to make sure all your questions are going to be answered.” Encourage those patients to bring someone with them who can speak their language and is part of their culture, so we get the nuances of what’s going on with the patient.

I’m very interested in learning more about that finding because I don’t think we have all the answers. One thing Dr [Maria] Lopes brought up is how we can help our patients get the access they need. For patients who are culturally different from the provider, having telehealth or e-consults available for patients, which we do in our office, is so important. Not every physician in our office does it, but several do. That makes it easy to triage that person and say that this person has psoriasis, so they need to come in and get started on a medication. Once they’re started and doing fine, barring needing to come in for labs—we can navigate that at a distance—they can be seen by e-consult. They don’t have to come in. That’s an easy 1. For a lot of things, once you’re on a medication and stable, we could bring you in for interval lab monitoring as needed.

The other thing we’ve instituted that helps patients of different cultures is that we have an in-house pharmacist. We were early adopters of this. A lot of departments and a lot of multispecialty practices are doing this. We have an in-house pharmacist and an in-house pharmacy helper to help us with prior authorizations and patient education. That goes a long way. Things that aren’t in the exam room are helping us get our patients educated about what they have and getting them the medicines they need. Our ability to get prior authorizations approved with these helpers has gone through the roof since we started using them. We’ve been using them for 4 or 5 years.

Ryan Haumschild, PharmD, MS, MBA: I’m a big fan of including the pharmacist as part of the care plan, especially with a lot of these agents that need so much education and dose titration. Timely access for time to treatment and a good proportion of these covered goes a long way, especially with integrated specialty pharmacy within the health system.

Transcript edited for clarity.

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