Community Outreach Initiatives in Dermatology - Cross-sectional Study

doi:10.21203/rs.3.rs-2468731/v1

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Community Outreach Initiatives in Dermatology - Cross-sectional Study

https://doi.org/10.21203/rs.3.rs-2468731/v1

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Disparities in health care coverage, chronic diseases, mental health, and mortality among racial and ethnic groups, incarcerated individuals, and low-income communities are prevalent in the United States (U.S.). There is a need to address these shortfalls in access to care. Community outreach efforts can help reduce these disparities and bridge access to adequate healthcare to meet patient needs. In dermatology, there is a lack of studies assessing community outreach initiatives and whether these initiatives address diverse community needs. This cross-sectional study was designed to identify and categorize community outreach initiatives offered by academic dermatology programs in the U.S. to recognize potential areas of improvement to better serve our communities. We surveyed 142 ACGME-accredited U.S. dermatology programs regarding their community outreach initiatives and obtained information for 68% of the programs. Most dermatology residency programs provided traditionally popular community outreach initiatives like skin cancer screenings and free general dermatology clinics. Conversely, very few programs offered initiatives addressing the needs of patients of color, minoritized communities such as American Indians, or chronic skin disease patients. These may be opportunities to broaden our definition of community outreach and address the dermatological needs of all communities.

dermatology residency programs

community outreach

volunteer initiatives

skin of color

skin cancer

Community outreach improves public health in several ways, including free health care, disease screenings, public education, and social engagement. In dermatology, there is a lack of studies assessing community outreach initiatives and whether they reflect community needs. While skin cancer prevention and pharmaceutical access/affordability are included in the American Academy of Dermatology (AAD) Association’s current advocacy priorities, expanding these initiatives may improve community engagement and access to care in dermatology.¹ This cross-sectional study aimed to identify and categorize the range of community outreach initiatives offered by academic dermatology programs in the United States (U.S.) to recognize potential areas of improvement to better serve our communities.

We identified 142 ACGME-accredited U.S. dermatology programs and obtained information regarding their community outreach initiatives by contacting program coordinators/directors (a maximum of three times) and visiting program websites. Initiatives were categorized as skin cancer prevention/screening, free general dermatology clinics, pediatric outreach (i.e. Camp Discovery), student education and career exploration (primary and secondary schools), global health, skin of color (excluding non-volunteer clinics), and miscellaneous. Initiatives that were halted due to the COVID-19 pandemic were also included.

We obtained information for 68% (96/142) of dermatology programs. Initiatives were advertised online for 23.9% (23/96) of programs. Programs averaged 2.6 initiatives. Of the 238 initiatives collectively offered, 42.9% (102) were related to skin cancer prevention/screening, and 32.4% (77) were free general dermatology clinics (Fig. 1A). Thirteen programs engaged in global health. Nine programs participated in summer camps, such as Camp Discovery, to target pediatric skin conditions. Eight programs worked with students in primary and secondary schools to increase interest in science, healthcare, and dermatology. Four programs offered skin of color initiatives, which included skin cancer screenings for Black women, high school talks on skin of color conditions, and hairstyling events for traction alopecia education and prevention. The top three miscellaneous initiatives were free tattoo removal, free dermatologic care for Native American communities, and support groups for patients with chronic dermatoses (Fig. 1B). Programs with the most initiatives offered averaged 17 residents per program (U.S. average = 12) (Fig. 2). The four programs that provided volunteer skin of color initiatives averaged 13 residents per program. The skin of color population in areas where skin of color initiatives were offered averaged 28.2% (U.S. average = 38% per U.S. Census Bureau).

Our data indicate that skin cancer initiatives were the most common outreach category amongst U.S. academic dermatology programs. These results highlight the specialty's longstanding emphasis on skin cancer prevention and education and align with the current priorities of the AAD. Another common initiative identified was providing access to underserved populations through free general dermatology clinics. Several programs offered global health initiatives, reflecting the global dermatologic disease burden.²

Dermatology residency program-sponsored support groups for chronic dermatoses were limited. Patients with chronic skin conditions are at an increased risk of developing anxiety and depression.³ Addressing the psychosocial burden of these diseases can be a vital aspect of disease management.³ While national and regional support groups may address some of those patients' needs, opportunities may exist to improve patient support through targeted outreach.

Strikingly, only four dermatology programs offered skin of color community health outreach initiatives.⁴ This may reflect the well-documented gaps in access to dermatologic care for minoritized races.^5–8 While at least 19 institutions have established ethnic skin/skin of color centers, these specialty clinics may not reach uninsured patients and those of lower socioeconomic status. Thus, our results suggest the need for improved community outreach efforts for this patient demographic. By offering more skin of color community outreach opportunities, skin of color public awareness and education may improve, better reflecting community needs. Furthermore, the lack of skin of color dermatology in resident education is well-recognized.^8,9 Improved outreach in this area may strengthen skin of color education and training for residents.⁸

A few dermatology programs offered outreach programs to Indian Health Services (IHS), with dermatology faculty volunteering at IHS hospitals and serving Navajo Reservations. American Indians experience drastic healthcare inequality and poor health outcomes.^10,11 Most American Indians live on reservations or in rural communities and are served through IHS.^10,11 Unfortunately, IHS is significantly underfunded and thus focuses its efforts on providing primary and emergency care services.⁹ Further, access to dermatologic care is extremely limited given the nationwide shortage of dermatologists, particularly in rural areas.¹¹ Strikingly, it was estimated that only 5% of the American Indian population visited a dermatologist in 2002, despite suffering from skin diseases.¹⁰ Through community outreach efforts, sustainable access to dermatological care for American Indian populations can help address these shortfalls.

Free tattoo removal was another miscellaneous outreach initiative offered by a few dermatology programs. Laser tattoo removal can be indispensable in helping formerly gang-involved and incarcerated individuals reintegrate into society.¹² Expanding these efforts to provide free laser tattoo removal services can help meet this patient population's health care and socioeconomic needs.

Limited funding sources and skewed fundraising strategies may explain why many community outreach initiatives are focused primarily on skin cancer screening and prevention. Most endowments at dermatology programs in the U.S. are for advancing research and education.¹² Very few support community service opportunities.⁹ Soliciting funding for more diverse outreach initiatives may be a strategy to consider.¹³ On average, larger dermatology residency programs offered the most community outreach initiatives, suggesting that the number of dermatology faculty and residents may also be a factor.

The results of this study should be considered within the context of its limitations. First, we could not obtain information for 32% (36) of the programs we contacted, signifying some non-response bias. Further, information on community-led and individual outreach endeavors was not collected, demonstrating that outreach efforts beyond the purview of U.S. dermatology residency programs may address some community needs. Future studies should consider quantifying community needs and assessing to what degree dermatology residency program initiatives meet them.

In conclusion, dermatology community health initiatives are important ways to engage with and contribute to our communities. With the public commonly using the internet to learn about available outreach initiatives in their community, especially in the era of COVID-19, public awareness may benefit from accurate and transparent online promotion. While most dermatology residency programs provide traditional community outreach like skin cancer screenings and free clinics, there are opportunities to broaden our definition of community outreach and address the needs of all communities.

Statements and Declarations: The authors have no competing interests to disclose.

Contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Madelaine Fritsche and Natella Maglakelidze. The first draft of the manuscript was written by Madelaine Fritsche and Natella Maglakelidze and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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No competing interests reported.

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Community Outreach Initiatives in Dermatology - Cross-sectional Study

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