Virtual care, equity and inclusion in dermatology
Socioeconomic and cultural factors may reduce fairness of care in teledermatology (1,070 words, 5 minutes)
The Skin Spectrum Weekly e-newsletter is supported by Bausch Health Canada
While the Covid-19 pandemic has driven the adoption and technological advances of teledermatology, there are still barriers to fairness in care.
Dr. Boluwaji Ogunyemi discussed this idea in an interview with The Chronicle of Skin & Allergy (Dec. 2021; 27(8):4).
Dr. Ogunyemi is the Assistant Dean, Social Accountability, Faculty of Medicine, Memorial University of Newfoundland & Labrador in St. John’s. He noted the evolution in dermatology care as the Covid pandemic has progressed through various waves.
“We are in an adaptive mode now,” said Dr. Ogunyemi. “We are adapting to delivering care in a pandemic. Dermatologists are leaders in virtual care. Some best practices have developed in virtual care.”
However, he noted that physicians should be aware that not all patients will have the same access to virtual care. Further, access to technology is not the only potential stumbling block.
Barriers to effective teledermatology include:
Cost of technology a barrier
Lack of comfort with technology
Travel time and costs to a site equipped for live teleconsultation
The need for a language translator during a virtual visit
Cultural differences that could lead to miscommunication
“There may be gaps in virtual care, and we need to recognize the inequities in existing care and ensure that virtual care does not exacerbate health inequities,” said Dr. Ogunyemi. “We need to use virtual care to reduce the gaps in health inequities.”
From the literature on language and culture barriers in medicine
Language-centred approach to care improvement in a pediatric dermatology clinic
As a quality improvement initiative supported by the Department of Dermatology at Massachusetts General Hospital, the American Academy of Dermatology, and the Society for Pediatric Dermatology, the authors of this paper established monthly pediatric dermatology “Spanish clinics.”
These clinics scheduled Spanish-speaking patients on the same day and utilized a dedicated, live interpreter who stayed with the clinical team throughout the clinic.
Patient-reported satisfaction scores with this program were high—averaging 9.8 out of 10. The new approach was preferred by 90.5% of patients compared to traditional appointments.
The physician who ran the “Spanish clinics” said it allowed for more efficient care both in the new monthly clinics and in all other clinics during the same period.
How telemedicine may exacerbate disparities in patients with limited English proficiency
In this letter, the authors identify ways that the widespread use of teledermatology may increase the unfairness of care experienced by people with limited English proficiency. In particular, they discuss how using store-and-forward teledermatology means patients have to download and install hospital-approved software, navigate an online medical record, and follow photography instructions—while directions for all of these steps are typically written in English.
The authors make recommendations to try reducing this problem, including using more graphics-based directions, asking every patient if they need an interpreter, and having versions of instructions available in other languages.
Barriers to healthcare access in pediatric dermatology: A systematic review
This systematic review examined the barriers to healthcare access mentioned in the pediatric dermatology literature. The authors looked at sociocultural and individual barriers and systemic ones.
Sociocultural factors included:
Community or racial/ethnic group beliefs
Communication trends
Language barriers
One example of group beliefs they mentioned was a study that found members of a Hispanic community believed childhood acne was a rite of passage—even though they recognized acne should be treated.
Language barriers also led to misunderstandings between physicians and patients, and patients using medication incorrectly.
Patient factors associated with dermatology outpatient non-attendance: An analysis of racial and ethnic diversity
In this study from Australia, researchers tried to identify factors that might lead to people from culturally and linguistically diverse (CALD) communities not showing up for dermatology appointments.
The authors identified several trends using a retrospective cross-sectional study of dermatology appointments at a public hospital in one of Australia's most racially and ethnically diverse communities.
Patients aged 18 to 45 years were 61% more likely not to attend compared to older patients.
To the researchers ' surprise, those born in Oceania, Middle East Asia, and Australia were more likely to miss an appointment. Patients born in East and Southeast Asia were more likely to attend.
Those who spoke Arabic at home were more likely to miss appointments, while those who spoke Vietnamese at home were more likely to attend.
VIDEO: Language barriers in medicine
At the intersection of skin and society
A coalition of more than 25 Canadian national Indigenous organizations has developed a new National Indigenous Economic Strategy (NIES), according to a press release.
This will be the first economic strategy to be built and designed exclusively by Indigenous leaders, institutions, and organizations from across Canada.
The strategy can be read at this link and is divided into four strategic pathways, People, Lands, Infrastructure and Finance.
Policy changes and investments recommended in the strategy will not only help correct the exclusion of Indigenous peoples from economic opportunity but will benefit all Canadians, according to the NIES developers. They write that research has found that if the gap in opportunities for Indigenous communities was closed, it would boost more than $30 billion to Canada’s GDP. This includes an annual increase of $6.9 billion in employment income from the employment of 135,000 more First Nations, Métis, and Inuit people. Reducing poverty among Indigenous peoples is also expected to save federal, provincial and territorial governments more than $8 billion a year.
“Canada has become wealthy from the natural resources of Indigenous lands while many Indigenous people continue to live in poverty,” NIES spokesperson Dawn Madahbee Leach said in the release. “The four strategic pathways are designed to shift the status quo from managing poverty to growing prosperity. A recent study by the Canadian Centre for Policy Alternatives found that Indigenous children in Canada are more than twice as likely to live in poverty than non-Indigenous children. The time for this strategy is now—to accelerate our collective efforts to eradicate poverty and achieve a more inclusive Canadian economy.”
This week
June 13 to 19 is Diabetes Awareness Week in the U.K.
June 13 is International Albinism Awareness Day
June 16 is International Day of the African Child
Something to think about in the week ahead…
Next week
Our coverage of the 2022 Indigenous Skin Spectrum Summit begins with the keynote presentation by Dr. Dana Slape on the challenges of bringing dermatology to incarcerated populations—populations that are disproportionately made up of ethnic minorities. Dr. Slape, Australia’s first Aboriginal dermatologist, practices in Goulburn, NSW, Australia.
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