Differences in Face-to-Face Time Spent With a Dermatologist Among Patients With Psoriasis Based on Race and Ethnicity
Psoriasis is a chronic inflammatory skin condition frequently managed by dermatologists. Dermatologists have an obligation to provide each patient with psoriasis with adequate time to address their concerns and develop strong communication and trust. Ineffective physician-patient communication can mean poor treatment adherence, comprehension, satisfaction, and outcomes for the patient.1 It is unclear whether differences exist in the amount of time a dermatologist spends with a patient with psoriasis based on race or ethnicity. We aimed to evaluate the association between a patient’s race and ethnicity and time spent with a dermatologist for psoriasis treatment.
We performed a cross-sectional study of data from the National Ambulatory Medical Care Survey from 2010 through 2016.2 Data were analyzed January 3 to April 24, 2022. We conducted multivariable linear regression analyses adjusted for age, sex, type of visit (follow-up or new patient), visit complexity based on the number of reasons for visit, insurance status, psoriasis severity on the basis of systemic psoriasis treatment or phototherapy, and complex topical regimen (3 or more topical agents) to evaluate the association between patient race and ethnicity and visit duration for psoriasis treatment with a dermatologist. Race and ethnicity were self-reported by patients. The eMethods in the Supplement provides further details. This study was categorized as exempt by the University of Southern California Institutional Review Board, and the requirement for informed consent was waived because only deidentified data were used. We followed the STROBE reporting guideline. Statistical tests were 2-tailed, and a 2-sided P < .05 was considered statistically significant.
A weighted estimate of 4 201 745 (95% CI, 3 688 629-4 714 862) patient visits for psoriasis was identified. Of the tabulated demographic characteristics, a significant difference existed in age (37.2 [95% CI, 32.0-42.4] years for Asian patients vs 44.7 [95% CI, 33.4-56.0] years for Hispanic patients vs 33.3 [95% CI, 16.9-49.7] years for Black patients vs 54.8 [95% CI, 51.6-58.0] years for White patients; P = .001) and complex topical regimen (11.8% among Asian patients vs 1.5% among Black patients vs 1.1% among White patients; P = .03) among the groups (Table 1). Mean duration of visits was 9.2 (95% CI, 4.4-14.1) minutes with Asian patients, 15.7 (95% CI, 14.2-17.3) minutes with Hispanic or Latino patients, 20.7 (95% CI, 14.5-26.9) minutes with non-Hispanic Black patients, and 15.4 (95% CI, 13.5-17.3) minutes with non-Hispanic White patients. Visits with Asian patients had a 39.9% shorter mean duration compared with visits with White patients (β coefficient, −5.747 [95% CI, −11.026 to −0.469]; P = .03) and a 40.6% shorter mean duration compared with visits with non-Asian patients as a single group (β coefficient, −5.908 [95% CI, −11.147 to −0.669]; P = .03) (Table 2).
Results of the present study suggest that Asian patients with psoriasis receive significantly less face-to-face time with a dermatologist compared with patients of other races and ethnicities. This study supports the results of previous studies in which Asian patients were found to be less likely to receive counseling from physicians compared with White patients.3,4 Paradoxically, Asian individuals tend to present with more severe psoriasis compared with individuals of other races and ethnicities.5
The etiology of these differences is unclear. It is possible that factors, such as unconscious bias, cultural differences in communication, or residual confounding may be responsible for the observed findings.3,6 Further research is needed to understand the underlying factors responsible for the differences observed in this study.
This study has limitations. Visit duration was self-reported by the physician or their staff and had been studied in other fields; formal validation studies are pending. Missing data on race and ethnicity were imputed using a sequential regression method.2 It is possible that those patients who did not report race and ethnicity may have different characteristics affecting visit duration vs those who did report this information.
Dermatologists spend less time with Asian patients with psoriasis compared with patients of other races and ethnicities. Dermatologists need to allow sufficient time to develop strong physician-patient communication regardless of patient background.
Accepted for Publication: May 6, 2022.
Published Online: August 3, 2022. doi:10.1001/jamadermatol.2022.2426
Corresponding Author: April W. Armstrong, MD, MPH, Department of Dermatology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, KAM 510, MC 9034, Los Angeles, CA 90089 (armstrongpublication@gmail.com).
Author Contributions: Dr Wu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Wu.
Drafting of the manuscript: All authors.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Wu.
Administrative, technical, or material support: All authors.
Supervision: Armstrong.
Conflict of Interest Disclosures: Dr Armstrong reported receiving personal fees from AbbVie and Regeneron for research funding and serving as a scientific adviser and speaker; Bristol Myers Squibb, Dermavant, Dermira, Eli Lilly & Co., Janssen, Novartis, and UCB Pharma for research funding and serving as a scientific adviser; Modernizing Medicine Ortho Dermatologics, Sanofi Genzyme, Sun Pharma, Pfizer, Almirall, Arcutis Biotherapeutics, ASLAN Pharmaceuticals, Beiersdorf, EPI Health, Incyte, and Nimbus Therapeutics for serving as a scientific adviser; and Boehringer Ingelheim and Parexel for serving as a Data Safety Monitoring Board member outside the submitted work. No other disclosures were reported.
Disclaimer: Dr Armstrong is on the Editorial Board of JAMA Dermatology, but she was not involved in any of the decisions regarding review of the manuscript or its acceptance.
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