Study Shows Caregivers Prefer Dermatology Specialists Over PCPs for Pediatric Atopic Dermatitis

Consultation from dermatology specialists may provide better care delivery and disease control outcomes for the treatment of atopic dermatitis (AD) in children compared with primary care providers (PCPs), according to study findings published recently in Journal of Pediatric Health Care.

The most common chronic skin condition in children, AD management has been hindered by disproportionate access to dermatology specialists, particularly for Black and Latinx children who report a significantly higher rate of emergency department and primary care visits for the disease than White children.

For those without access to dermatology specialists, AD is often treated by PCPs, but researchers note that these providers have reported difficulty in managing the disease.

“Understanding how caregivers perceive access to specialty care for childhood AD may facilitate future interventions targeting improved access to care. In addition, an increased understanding surrounding health care use for Black and Latinx children with AD may lead to more equitable AD care and improved outcomes,” said the study authors.

They conducted an exploratory survey to assess preferences and barriers of accessing dermatology specialty care for childhood AD in a racially and ethnically diverse sample of children treated at Dell Children’s Medical Center in Austin, Texas.

A total of 50 caregivers of children aged 3 months to 17.2 years with AD were enrolled in the study (mean [SD] age, 4.3 [4.4] years; 40% female). Of the study cohort, 54% identified as Hispanic/Latino ethnicity, 42% were White, 26% were Black, and 10% were Asian/Native American/Pacific Islander.

Polled on whether they felt the PCP and dermatology specialist listened to their concerns about their child’s AD, caregivers were shown to agree (38%) or strongly agree (62%) for both types of providers. Participants who had seen a dermatology specialist were then asked if they felt a difference in how their PCP and their dermatology specialist cared for their child’s AD, of whom 26% strongly agreed, 45% agreed, 17% neither agreed nor disagreed, and 12% disagreed.

Although many participants (32%) reported that it was too soon to tell if their child’s AD was under better control since seeing a specialist, another 33% strongly agreed, 26% agreed, and 9% neither agreed nor disagreed that this was the case. Moreover, most participants either agreed (36%) or strongly agreed (34%) that they wished they would have been seen sooner by a specialist, with 10% neither agreeing nor disagreeing and 19% disagreeing.

A majority of caregivers with children treated by dermatology specialists wanted to continue receiving specialty care, with 41% strongly agreeing, 57% agreeing, and 2% neither agreeing nor disagreeing.

Several barriers were cited by caregivers in seeing a dermatology specialist:

• Ability to obtain an appointment quickly (n = 9)
• Difficulty leaving work (n = 7)
• Obtaining a referral (n = 6)
• Obtaining child care for siblings (n = 4),
• Obtaining transportation (n = 3) and cost of transportation (n = 2)
  

“Future reseach should be conducted to identify and reduce racial and ethnic disparities in childhood AD, particularly regarding equitable access to health care,” concluded researchers. “Once this is better understood, PCPs will be instrumental in implementing any suggested practice changes.”

Reference

Croce EA, Rathouz PJ, Lopes FCPS, et al. Caregiver preferences and barriers toward accessing pediatric dermatology care for childhood atopic dermatitis. J Pediatr Health Care. Published online May 5, 2022. doi:10.1016/j.pedhc.2022.04.003