677 Need for improved access to dermatologic care in underserved populations

Background: Underserved populations often have difficulty accessing dermatological care and frequently seek care from emergency rooms (ER) and urgent care centers (UCC). Teledermatology has reduced wait times for visits and increased healthcare access. We performed a retrospective study to determine if underserved populations would benefit from implementation of a “real time” dermatology e-consult service in local ERs and UCC. Methods: Our retrospective study examined 1,272 referrals to University of Rochester Dermatology (UR-Derm) from 11 UCC and 3 ERs between January 2021 and August 2022. Outcomes included percentage of completed referrals, patient insurance type, patient self-identified race, and whether the patient lived in a “high risk” zip code. Chi-square tests, performed at 0.05 significance level, identified significant trends. Results: Our referral population contained mostly white patients (70.7% white; 20.8% Black; 8.5% Hispanic-Latino) with a mean age of 39.2±19.6 years. The majority of referrals were not seen in UC-Derm (seen = 39.9%; not seen = 57.6%). Fewer UCC referrals were for patients in “high risk” zip codes (low-risk = 81.7%; high-risk = 18.4%; p<0.01); whereas 34.1% ER referrals live in high-risk zip codes. Insurance type differed across referrals (p<0.01) with predominantly Medicaid for ER referrals (53.5%) and private insurance for UCC referrals (49.3%). More ER referral patients self-identified as Black (ER = 29.6% vs. UCC = 15.2%; p<0.01) or Hispanic-Latino (ER = 11.8% vs UCC = 6.4%; p=0.03). Conclusions: Our results demonstrate the need for improved access to dermatologic care for ERs and UCC. A “real-time” dermatology e-consult service would improve overall access to dermatologic care, as well as improve care for underserved populations that utilize the ER and UCC primarily for their health care.