BackgroundAccess to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care.MethodsA systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions.ResultsDespite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence.ConclusionsWhile findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Aims To identify significant patient and system access barriers and facilitators to dermatology care in one rural health system with limited dermatology appointment availability. Design Mixed methods study using data from electronic medical records, patient surveys, stakeholder semi‐structured interviews, and service area dermatologist demographics. Retrospective data were collected between 1 January 2017–1 March 2018, and interviews and surveys were conducted between June 1–August 31, 2018. Participants were recruited from two primary care practices in one rural Maine regional health system. Methods Findings from thematic analyses, descriptive statistics, and statistical modelling were integrated using Chi‐square tests for homogeneity to develop a unified understanding. Statistical modelling using odd‐ratio logistic and linear regression were performed for each outcome variable of interest. Results Urgent referrals by primary care increased the likelihood of dermatology care overall (OR: 6.771; p = .007) and at nearby sites with limited availability (OR: 4.024; p = .024), but not at geographically further sites with higher capacities (p = .844). Referral under‐diagnosis occurred in 20.8% of those biopsied. Older (p = .041) or non‐working (p = .021) patients were more likely to remain unevaluated than seek more available but geographically further care. Conclusions In rural areas with scarce appointment availability, primary care provider diagnostic accuracy may be an important barrier of dermatology care receipt and health outcomes, especially among at‐risk populations. Impact Although melanoma mortality rates are decreasing throughout the US, little is known about why rates in Maine continue to rise. This study applied a comprehensive approach to identify several patient and system access barriers to dermatology care in one underserved rural regional health system. While specific to this population and large service area, these findings will inform improvement efforts here and support broader future research efforts aimed at understanding and improving health outcomes in this rural state.

Psoriasis is a chronic, autoimmune, and inflammatory disorder that impacts the skin and joints, with the propensity to produce devastating psychosocial, economic, and occupational effects. These are often not solitary; for example, psychological manifestations may impact one’s occupational and economic statuses. The purpose of this review is to raise awareness of these consequences of disease that clinicians may consider incorporating into a patient-centered model of care.

Background With malignant melanoma incidence rates at a historic national high and greater tumor thickness being the most significant prognostic determinant, early lesion detection and treatment remain the most crucial factors for improving health outcomes. Objective The aim of this study was to design and pilot a survey instrument to document patients’ perceived barriers to dermatology care access. Methods A retrospective, descriptive design and a convenience sample of 50 adult participants via a conceptually derived survey were used. Data analyses included descriptive statistics and frequencies; the survey was designed to be analyzed in a subsequent study with other types of data that were not collected as part of this pilot. Results Twenty-one (42%) of participants reported receipt of dermatology care, five (10%) reported no care, and 24 (48%) did not respond to this question. Overall, 30 surveys (60%) were returned incomplete to varying degrees. Limitations Limitations included a small sample size from a homogenous population with access to dermatology care. The reliability and validity of this tool were not evaluated. Conclusions It was unclear whether lower completion rates were attributed to the survey or study design, but several research-driven suggestions were made that may be helpful in improving this tool for future use.

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