Resource Management Challenges in Rural Dermatological Care: A Mapping Review

Skin cancer prevalence in the United States is rapidly on the rise, particularly in rural communities where individuals are subjected to heavy sunlight exposure through occupations such as agricultural work and construction. These geographic regions are often lacking in dermatologic specialty care, thus increasing the disease burden of skin conditions in primary care settings. Access barriers to specialized dermatology care are exacerbated by prolonged wait times to schedule an appointment, travel demands, and a relative paucity of dermatology providers in rural areas as compared to urban areas. In rural communities, the high burden of skin diseases, the logistical challenges, and the shortage of dermatologists lead to increased reliance on primary care physicians (PCPs) for dermatological care. This review aims to identify barriers to dermatology care in rural communities, understand challenges faced by PCPs related to dermatological management, and explore modalities that are currently being used to streamline clinical workflows for PCPs. Dermatology training for PCPs consists primarily of pre-clinical exposure to the field, and it has been reported that there is a relative lack of opportunity for training to further enhance postgraduate dermatology knowledge. Recent studies demonstrate that novel educational and infrastructural support to primary care clinics has had substantial positive impacts on the ability of primary caregivers to provide accurate, cost-effective dermatologic care in addressing skin conditions, as well as increasing diagnostic confidence. Regular skin examinations, dermoscopy, and digital transformation of images are also shown to improve detection and diagnostic accuracy. Interventions like the use of smartphones, teledermatology, and dermoscopy show potential for improving care but must be thoroughly evaluated for effectiveness before widespread adoption in primary care settings.