Atopic dermatitis: improving patient access to health care in dermatology

Tiago Torres, Serviço de Dermatologia, Centro Hospitalar Universitario de Santo António, Porto, Portugal Margarida Gonçalo, Serviço de Dermatologia, Centro Hospitalar Universitário de Coimbra (CHUC) e Clinica de Dermatologia, Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal Maria J. Paiva-Lopes, Centro Hospitalar Universitário Lisboa Central (CHULC)–Hospital dos Capuchos e Hospital Dona Estefânia, Nova Medical School-Universidade Nova de Lisboa, Lisboa, Portugal Cristina Claro, Centro Hospitalar de Lisboa Ocidental (CHLO)–Hospital de Egas Moniz, Hospital da Luz de Lisboa, Hospital da Luz de Oeiras, Portugal, Portugal Paulo Varela, Centro Hospitalar de Vila Nova de Gaia/Espinho, Hospital da Lapa, Lisboa, Portugal João M. Silva, Centro Hospitalar de Lisboa Norte (CHLN)–Hospital Santa Maria, Hospital CUF das Descobertas, Clínica CUF Alvalade, Clínica Dermatológica Dr. João Maia Silva, Portugal Ana Cordeiro, Centro Hospitalar Lisboa Central (CHLC)–Hospital Dona Estefânia, Hospital da Luz da Lisboa, Portugal, Lisboa, Portugal Pedro Mendes-Bastos, Hospital CUF Descobertas, Centro de Dermatologia de Lisboa, Lisboa, Portugal

Objective: The present study on atopic dermatitis (AD) in Portugal aims to characterize patient needs and discuss measures to improve health care in dermatology, particularly in cases of moderate to severe disease. Methods: The study was conducted in three phases—(1) data collection on the patient access to healthcare and subsequent analysis; (2) critical evaluation of the data in individual interviews with dermatologists and one pediatrician; and lastly, (3) data discussion in consensus meetings to validate the existing care capacity in dermatology, to identify gaps in care for patients with AD and to define mitigation strategies. Results: In Portugal, it is estimated that AD affects ~ 360,000 patients, 70,000 of whom have moderate to severe disease. Healthcare capacity analysis confirmed that the private system plays an important role in the management of AD. It is estimated that 30% of patients rely solely on the Portuguese public health service. Nevertheless, patients with moderate to severe disease can only access advanced targeted therapies from public healthcare providers. Analysis of public care capacity in dermatology shows relevant gaps in the referral system, the geographical coverage of specialized centers, the number of specialists and high waiting times for first appointments. Considering the negative impact of the disease on patients’ quality of life, 86% of patients with AD use private settings to better manage their disease. Conclusion: In conclusion, private setting bridges the gaps in public health care capacity in dermatology, and therefore, it is crucial for patients with AD. However, a major limitation is the lack of reimbursement for advanced targeted therapies recommended for moderate to severe AD when they are prescribed in a private setting, thus compromising patient access to these therapies. A possible strategy could be to extend the prescription of these therapies to a private setting based on a reimbursement model similar to that outlined in Act 48/2016 of 22 March.

Palabras clave: Health equity. Health services accessibility. Essential drugs. Dermatology. Delivery of health care. Atopic dermatitis.