"Lack" and "Finally": A Qualitative Analysis of Barriers and Facilitators in Rare Disease Healthcare.

This study explored the experiences of adults with diverse rare diseases (RDs) and RD caregivers with barriers and facilitators to healthcare access in the United States (US), including during the early part of the COVID-19 pandemic, and their recommendations for improving access. Adults with RDs and parents/caregivers to children with RDs (N = 1128) completed open-ended survey items. Responses were analyzed using thematic analysis. The primary theme identified regarding barriers to healthcare was "lack"; participants reported challenges in obtaining an accurate diagnosis, effective management/treatment, health insurance coverage, and social support. The primary theme identified regarding facilitators was "finally"; participants reported a need for persistence to access a diagnosis, RD experts, as well as social support and advocacy. Recommendations for improving healthcare for RDs mirrored the barriers and facilitators identified, including improving knowledge/awareness of RDs and investing in RD research that could improve diagnosis and treatment. Participants' healthcare experiences varied widely during the COVID-19 pandemic, with some reporting that telehealth improved care and others reporting disruption due to telehealth. Even though individual diagnoses are rare, there are shared challenges to healthcare access and common opportunities for improvement. Policy recommendations regarding RD healthcare focus on improving affordable and timely access to knowledgeable providers, diagnosis, and medications/treatments.