# Dermatology Appointments as an Indicator of Systemic Healthcare Issues

## TL;DR

Long waits for dermatology appointments in Puerto Rico hurt patients' quality of life, especially in underserved areas.

## Contribution

The study connects dermatology appointment delays to broader healthcare access issues in Puerto Rico.

## Key findings

- 55% of participants waited over three months for a dermatology appointment.
- Women and patients in medical dermatology services reported worse quality of life impacts.
- Over 65% of patients used over-the-counter remedies due to appointment delays.

## Abstract

Introduction

Puerto Rico (PR), a territory of the US, faces economic challenges that have resulted in healthcare strain and a shortage of dermatologists. This shortage, coupled with a growing aging population, has led to prolonged wait times for dermatology appointments. These delays negatively affect patients’ quality of life (QOL), especially in underserved areas.

Methods

This cross-sectional study assessed wait times for dermatology appointments in PR and their impact on patient QOL. During the summer of 2023, 464 participants from 12 dermatology clinics completed a questionnaire that included the Dermatology Life Quality Index (DLQI). The survey collected data on demographics, wait times, and the use of over-the-counter remedies. Statistical analyses, including t-tests and chi-squared tests, were used to examine differences between groups based on gender and type of service.

Results

The study revealed that 55% of participants (n = 255) waited more than three months for an appointment, with an average wait time of 2.5 months (SD = 2.49). Women had longer wait times than men (2.59 vs. 2.30 months, p < 0.05). More than 38.7% of patients (n = 179) reported worsening symptoms during the waiting period, and 65.5% (n = 305) resorted to over-the-counter medications or herbal remedies. DLQI scores indicated that 40% of participants (n = 186) experienced moderate to severe effects on their QOL, with women (mean DLQI score = 6.24, SD = 6.46) reporting a greater impact than men (mean DLQI score = 4.80, SD = 5.59; p = 0.008). Patients seeking medical dermatology services had significantly higher DLQI scores (6.24 vs. 3.38; p < 0.001), indicating a greater impact on QOL.

Conclusions

This study highlights the detrimental effects of prolonged wait times for dermatology appointments. The findings emphasize the need to address the dermatology workforce shortage, which disproportionately impacts rural and underserved populations. Strategic efforts to increase access to dermatology care are essential for improving patient outcomes and reducing healthcare disparities.