Assessing Access to Advanced Dermatologic Healthcare for Underinsured Free Clinic Patients

Abstract

Background: Agape Dermatology Student Run Free Clinic serves the dermatologic needs of underinsured patients in the Dallas-Ft. Worth community. Patients with complex or recalcitrant diseases can be referred to Parkland County Hospital system through Parkland Financial Aid (PFA) program, which provides financial assistance for medical services. The purpose of this study was to characterize the demographics and outcomes of patients referred from Agape Dermatology Free Clinic to Parkland PFA.

Methods: Data from Agape's electronic health record (AthenaOne) and Parkland's electronic health record (Epic) was collected from 2018 to 2022. Retrospective chart review was performed to obtain the following primary outcomes: patient demographics, reason for referral, status of referral, approval rates, and reason for denial for the PFA program.

Results:  Sixty-eight patients were referred from Agape Dermatology to Parkland PFA. The most common diagnoses for referral were: psoriasis (22.1%), vitiligo (10.3%) and lipoma (7.35%). The majority of patients reported Spanish as their primary language. Twenty-one patients were approved for PFA. The primary reason that patients did not receive PFA was failing to start their application. Barriers that may have prevented initiation of a PFA application include miscommunication, lack of expectations about the time and steps required to apply, language barriers, lack of printer resources, and inability to obtain documentation (e.g. employer letters or utility bills).

Conclusions: Our analysis has identified a substantial need for improving the referral process from a dermatology free clinic to more advanced healthcare. Future work includes conducting patient interviews and surveys to define individual challenges and implementing targeted interventions to optimize the PFA integration process.