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•1/5 of the United States population lives in rural America1
•Rural populations face decreased access to healthcare and
increased morbidity and mortality compared to their urban
counterparts2
•One factor playing into this health crisis is access to care
and the isolation from metropolitan areas and specialty
services that affect small communities.
•While 1/3 of primary care patients seek care for at least
one skin problem, there is a maldistribution of specialty
care available3
•Distance traveled to obtain dermatologic care has a
measurable effect on disease state
•Studies suggest for every 1-mile traveled for specialty care,
there was a 0.6% increase in Melanoma Breslow depth4
Introduction
Methods
Results
Dermatology clinics in rural communities decrease distance
traveled and increase the number of first-time patients
seeking care for skin conditions. Further investigation needs
to be done on improving access to dermatologic care and
addressing roadblocks to implementing more specialty clinics
in the rural US.
Figures
Rebecka M. Ernst MS31, Allison Sindle MD2
University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA1
Missouri Delta Medical Center-Department of Dermatology, Sikeston, MO 63801, USA2
Quantifying Access to Rural
Dermatology in Southeast Missouri
•Of 498 patients receiving care, 63 unique home zip
codes were reported (see Figure 1A and 1B)
•155 miles was the furthest distance traveled to receive
care
•54% of patients were seeing a dermatologist for the
first time (See Figure 2)
Participants seeing a dermatologist for the first time:
1. Were living on average 35.6 miles (mode= 31.8;
median=35.6) to the closest dermatologist
2. 59% (n=122) reported seeing a primary care provider
(PCP) for skin-related treatment
3. 41% of these PCPs were working in a clinic that
shared a zip code with the participant’s home address
Participants with previous dermatologist visits in another
city:
1. The average distance traveled was reduced by 29
miles on average (median=29 miles; mode=34 miles)
(See Figure 3).
2.The average distance traveled for these patients
before seeking care in Sikeston was 40.6 miles and
after was 18.4 miles (See Figure 4). The largest
reduction in travel distance was 155 miles.
Conclusion
•Nearly 500 participants completed a one-time
questionnaire detailing past dermatologic care
•These questionnaires were completed within the first 18
months of the opening of Missouri Delta Medical Centers’
(MDMC) Dermatology Clinic
•Participants included adults receiving care from the MDMC
Dermatology clinic who consented to participate
•Utilizing self-reported home zip code and healthcare
provider zip codes, drive time and miles traveled was
calculated.
1. “Health in Rural America.” National Institutes of Health, 15 July 2022,
newsinhealth.nih.gov/2022/03/health-rural-america.
2. Chen X, Orom H, Hay JL, Waters EA, Schofield E, Li Y, Kiviniemi MT. Differences in Rural and Urban
Health Information Access and Use. J Rural Health. 2019 Jun;35(3):405-417. doi: 10.1111/jrh.12335.
Epub 2018 Nov 16. PMID: 30444935; PMCID: PMC6522336.
3. Lowell BA, Froelich CW, Federman DG, Kirsner RS. Dermatology in primary care: prevalence and
patient disposition. Journal of the American Academy of Dermatology 2001; 45(2): 250-255. DOI link
4. Stitzenberg KB, Thomas NE, Dalton K, et al. Distance to diagnosing provider as a measure of access
for patients with melanoma. Arch Dermatol. 2007;143(8):991-998. doi:10.1001/archderm.143.8.99.
5. Brustrom J, Hunter DC. Going the distance: how far will women travel to undergo free
mammography? Military Medicine 2001; 166(4): 347-349.
References
Background
•In 2021 a new dermatology clinic opened in rural,
Southeast Missouri
•Before the opening of this clinic, the closest board-
certified dermatologist was over a 30-minute drive for
members of the community and even further for those
living outside of it
•Studies show patients are unlikely to travel more than 20
miles, even when care is free5
•Our aim is to quantify the effectiveness of this clinic
opening in regards to access to dermatologic care by
looking at drive time and first-time specialty care
Figure 1A: Missouri Home Zip Codes Figure 1B: Southeast MO Home Zip Codes
