Dermatology in the safety-net hospital

Safety-net hospitals provide care to those in need. Not surprisingly, dermatology has played a role in treating skin disorders that come through the doors of the nation’s safety-net hospitals.

Joerg Albrecht, MD

Benjamin F. Chong, MD, MSc

What’s involved in safety-net hospitals?

Safety-net hospitals tend to be large teaching hospitals located in large cities. These hospitals care for patients who are underinsured or uninsured, including dermatologic cases. In Friday’s session, “Dermatologists to the Rescue — Great Cases from Safety-Net Hospitals,” (F013), speakers addressed the important contributions dermatology clinics within safety-net hospitals have made for patients challenged by insurance coverage. 

“Some challenges of treating patients in safety-net hospitals include language and cultural barriers, patients with layers of psychosocial stressors and low medical literacy, which affects their ability to understand and adhere to treatment, a higher prevalence of underlying high-risk medical and psychiatric problems, problems with insurance, and limited drug formularies,” said Erin H. Amerson, MD, a dermatologist from the University of California San Francisco. “I get excited about showcasing our patients because they have so much to teach us.”

Real-life examples 

Dr. Amerson presented two patient cases. One represented a body lice infestation, its complications, and treatment, while the other focused on how to use systemic immunosuppressive medications, such as TNF inhibitors, in background infections (hepatitis B, tuberculosis) that are common in immigrant and refugee populations.

Benjamin F. Chong, MD, MSc, an associate professor of dermatology at the University of Texas Southwestern Medical Center in Dallas, shared his own experience with the Parkland Dermatology Clinic at Parkland Memorial Hospital in Dallas. The hospital, which opened in 1894, is best known for having treated President John F. Kennedy when he was assassinated in Dallas in 1963. 

“Our outpatient clinic handled 10,800 visits last year, providing phototherapy, dermatology surgery, patch testing, and teledermatology,” Dr. Chong said. “Parkland provided $1 billion in uncompensated care in 2018.”

Resources
and public safety

There are resources to care for patients with limited means to help them afford dermatologic care, according to Roy Mitchell Colven, MD, a dermatologist at the University of Washington in Seattle. Dr. Colven says the Affordable Care Act has helped move many patients in Washington State onto its state Medicaid program, with access to medications that otherwise empty charity programs. 

“All of us working in public or safety-net hospitals have seen far-advanced skin disease that ‘should have been’ cared for at an earlier point, but for many and often complex reasons, both extrinsic and intrinsic to the patient, the disease is allowed to go untreated,” Dr. Colven said. “I’m impressed by how
dedicated everyone who works here is and how much ‘esprit de corps’ exists. That’s why I’ve been here for more than 20 years. Once you start at a safety-net hospital, you stay there forever.” 

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