Clinical Settings and Patient Characteristics Associated with Outpatient Dermatology Care in Hidradenitis Suppurativa

Patients with hidradenitis suppurativa (HS) receive limited dermatologic care even though timely care is essential to minimize disease morbidity and progression. This retrospective cohort study examined whether clinical encounter setting and patient demographics were associated with outpatient dermatology follow-up among patients with HS.

Adults (≥18) from two health systems in a large southern U.S. metropolitan area with ≥2 clinical encounters from 9/10/2014-10/9/2020 and a diagnosis of HS at ≥1 visit were included. Outcomes included any outpatient dermatology visit and encounter setting-specific probabilities of outpatient dermatology as the next encounter.

A total of 3336 participants (77.7% Black, 72.8% female) with 9724 HS-related encounters were included. Outpatient care was received by 288/1364 (21.1%) of participants in the public system and 167/1972 (8.5%) in the private system. Few emergency department, inpatient, and ambulatory surgery encounters were followed by dermatology visits (2.8%, 2.7%, and 3.9%, respectively). The odds of dermatology care were lowest following emergency department encounters (aOR: 0.43, 95% CI: 0.30-0.61), inpatient hospitalization (aOR: 0.41, 0.27-0.63), and ambulatory surgery (aOR: 0.44, 0.21-0.89) compared to primary care. Patients seen most frequently in these settings had the lowest probability of any dermatology encounters during the study period (9.1% [95% CI: 6.4%-11.8%], 6.7% [3.9%-9.4%], and 9.1% [1.5%-16.7%], respectively). In the private system, patients with commercial insurance (aHR: 3.34, 1.78-6.23) and Medicare (aHR: 4.12, 95% CI: 2.00-8.51) were more likely to receive dermatology care than those with Medicaid. Patients who were white (aHR: 0.60, 0.39-0.93) or male (aHR: 0.58, 0.36-0.93) were less likely to receive dermatology care. In the public system, the hazard of receiving outpatient dermatologic care did not differ by demographic characteristics.

Few patients with HS had an outpatient dermatology encounter, with particularly low follow-up among patients with Medicaid in the private healthcare system. High acuity settings were associated with lower odds of outpatient follow up. Interventions that improve follow up among patients seen in high-acuity settings such as the emergency department or inpatient units may reduce morbidity, disease progression, and future need for emergency care among patients with severe disease.