Race and appointment availability influence continuity of care for chronic inflammatory skin disease: A cross-sectional study of United States practice data

J Am Acad Dermatol. 2025 Apr;92(4):753-760. doi: 10.1016/j.jaad.2024.11.047. Epub 2024 Dec 3.

Abstract

Background: In the management of chronic inflammatory skin disease (CISD), continuity of care may influence the achievement of long-term disease control. Barriers to care have been identified in this population, which may leave some patients more vulnerable to loss of follow-up.

Objective: We aim to identify predictors of continuity of care for CISD patients across demographic groups and health care practice types in the United States.

Methods: A cross-sectional study of National Ambulatory Medical Care Survey data was conducted on US outpatient CISD visits between 2011 and 2019 including a primary diagnosis of psoriasis, atopic dermatitis, acne, or rosacea.

Results: A total of 2747 visits, estimating 75.4 (95% CI: 70.9-79.9) million CISD encounters were identified during the period. Multivariate regression showed that Black patients had lower odds of establishing continuity of care relative to White patients (P < .01). Practices offering same-day visits had greater odds for patients with continuity (P < .05). Conversely, practices with lower overall wait times (≤1 month) were less likely to be associated with continuity of care (P < .01).

Limitations: Disease severity data were unavailable.

Conclusion: Both patient race and appointment availability predict differences in continuity of care, suggesting vulnerabilities may exist for some CISD patients requiring follow-up.

Keywords: atopic dermatitis; continuity of patient care; health care disparities; health services accessibility; psoriasis; skin diseases.

MeSH terms

  • Acne Vulgaris / therapy
  • Adult
  • Aged
  • Appointments and Schedules*
  • Black or African American / statistics & numerical data
  • Chronic Disease
  • Continuity of Patient Care* / statistics & numerical data
  • Cross-Sectional Studies
  • Dermatitis, Atopic / therapy
  • Female
  • Health Care Surveys / statistics & numerical data
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities* / ethnology
  • Healthcare Disparities* / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Psoriasis / therapy
  • Rosacea / therapy
  • United States
  • White / statistics & numerical data
  • Young Adult