Disparities in physician access for rheumatology, dermatology, and gastroenterology: a systematic review.

Abstract

Objectives: Substantial disparities in access to health care, including to physician specialists, hinder diagnosis, treatment, and outcomes for patients with immunological diseases; thus, more studies are needed to understand and address these disparities. This study aimed to evaluate factors associated with disparities in rheumatology, dermatology, and gastroenterology specialist access for patients with immunological conditions and the consequences of such disparities.

Study design: Systematic literature review.

Methods: Studies published between 2017 and 2023 examining US adults (≥ 18 years) with key immunological conditions receiving care by rheumatologists, dermatologists, and gastroenterologists were systematically reviewed. Thematic analyses of qualitatively synthesized data were used to evaluate disparities in specialist access (defined under "5 A's": affordability, availability, accessibility, accommodation, and acceptability) and the associated clinical/economic outcomes.

Results: Specialist access disparities and related outcomes were inconsistently evaluated across the 46 included studies, with limited evidence in gastroenterology. Common factors associated with specialist access disparities in rheumatology and dermatology included rural residence, insurance type (primarily Medicaid), Black or Hispanic race and ethnicity, and low regional specialist density. Frequent outcomes of this low access included higher disease severity, higher hospital admission and readmission rates, and higher numbers of emergency department visits. Importantly, studies described ways to improve specialist access across the 5 A's (eg, minimize structural barriers, use a multidisciplinary approach, promote telemedicine, increase health literacy, improve community partnerships).

Conclusions: Specialist access disparities were identified in rheumatology and dermatology. Conclusions in gastroenterology could not be inferred due to limited evidence. Evidence-based solutions are provided to address identified gaps in US health care.