Dermatology Section, Division of Immunology, Boston Children's Hospital, Harvard Medical School.
Tufts University School of Medicine.
Curr Opin Pediatr. 2022 Aug 1;34(4):359-366. doi: 10.1097/MOP.0000000000001137. Epub 2022 Jul 5.
To identify factors that impact accessibility to pediatric dermatology and review healthcare delivery models that improve access and address these barriers.
Up to one-third of pediatric primary care visits include a skin-related problem, yet pediatric dermatology subspecialist services are highly inaccessible. Workforce shortages and geographic, sociocultural, and economic barriers perpetuate inaccessibility. Teledermatology expands care, particularly to underserved or geographically remote communities, and reduces healthcare-related costs. Federal legislation to support telehealth services with adequate reimbursement for providers with parity between live, video, and phone visits will dictate the continued feasibility of virtual visits. Innovative care delivery models, such as language-based clinics, multidisciplinary teleconferencing, or embedded dermatology services within primary care are other promising alternatives.
Despite efforts to expand access, dermatology still ranks among the most underserved pediatric subspecialties. Improving access requires a multipronged approach. Efforts to expand exposure and mentorship within pediatric dermatology, diversify the workforce and clinical curriculum, recruit and retain clinicians in geographically underserved areas, and collaborate with policymakers to ensure adequate reimbursement for teledermatology services are necessary.
确定影响儿科皮肤科可及性的因素,并回顾改善可及性和解决这些障碍的医疗保健提供模式。
多达三分之一的儿科初级保健就诊包括皮肤相关问题,但儿科皮肤科亚专科服务极难获得。劳动力短缺以及地理、社会文化和经济障碍使可及性问题持续存在。远程皮肤病学扩大了医疗服务范围,特别是针对服务不足或地理位置偏远的社区,并降低了与医疗保健相关的成本。联邦立法支持远程医疗服务,并为提供者提供充足的报销,以实现现场、视频和电话就诊之间的平等,这将决定虚拟就诊的持续可行性。语言为基础的诊所、多学科远程会议,或在初级保健中嵌入皮肤科服务等创新的护理提供模式是其他有前途的替代方案。
尽管为扩大可及性做出了努力,但皮肤科仍然是最服务不足的儿科亚专科之一。改善可及性需要采取多管齐下的方法。努力在儿科皮肤科领域扩大接触和指导,使劳动力和临床课程多样化,在地理上服务不足的地区招聘和留住临床医生,并与政策制定者合作,确保远程皮肤病学服务的充足报销是必要的。