according to a study of a large national administrative data set.
“Patients with HS presenting to the ED for their disease exhibited high rates of ED return with low rates of dermatology follow-up after an initial ED visit,” lead study author Cynthia X. Wang, MD, MPHS, and colleagues in the division of dermatology and the Institute for Informatics, Washington University in St. Louis, wrote in JAMA Dermatology.
Patients who received opioid prescriptions and patients on Medicaid were more likely to return to the ED, they noted.
HS, a debilitating skin disease involving chronic follicular inflammation, frequently affects the axilla, anogenital, and inframammary areas, with painful nodules, abscesses, and sinus tracts that can form scars, the authors wrote. HS is linked with comorbidities including inflammatory bowel disease, obesity, diabetes, substance use, and psychiatric conditions, and is often misdiagnosed for an estimated 7-10 years.
In the retrospective cohort study, Dr. Wang and colleagues collected data from nationwide commercial and Medicaid databases. They included patients aged 18 to 64 years with two or more claims for HS and with at least one ED visit not resulting in admission for HS or a defined proxy (such as a related diagnosis of folliculitis, in a location typical for HS) between 2010 and 2019.
The median age of the 20,269 patients in the study was 32 years; most (82.9%) were female, and nearly 37% had commercial insurance and 63.2% had Medicaid. About half the patients on Medicaid were Black and 36.2% were White (race and ethnicity data were not available for commercially insured patients). In both insurance groups, the rates of comorbidities were high, including 22.5% with obesity and 11.9% with diabetes.
The researchers found that, at the index ED visit, 48.0% of patients had incision and drainage performed (51% among those with commercial insurance vs. 46.3% of those with Medicaid; P < .001); 72.6% of patients filled an oral antibiotic prescription within 7 days, with similar percentages in both insurance groups; and 48.9% filled an oral opioid medication prescription within 7 days (46.5% for commercial insurance vs. 50.3% for Medicaid; P < .001).
Regarding follow-up care, the investigators found that 17.2% of patients had at least one return ED visit for HS or proxy within 30 days (15.7% for commercial vs. 18.1% for Medicaid; P < .001), while 2.4% had a dermatology visit (5.3% for commercial vs. 0.7% for Medicaid; P < .001). In addition, 34% of patients had at least one return ED visit for HS or proxy within 180 days (27.2% for commercial insurance vs. 38% for Medicaid; P < .001), while 6.8% had a dermatology visit (14.1% for commercial vs. 2.5% for Medicaid; P < .001).
Patients with an opioid prescribed within 7 days of the ED visit were more likely to return to the ED, within 30 days (odds ratio, 1.67; 95% confidence interval, 1.54-1.80; P < .001), and within 180 days (OR, 1.48; 95% CI, 1.39-1.58; P < .001). But they were less likely to have dermatology follow-up within 30 days (OR, 0.78; 95% CI, 0.64-0.95; P = .01) and within 180 days (OR, 0.81; 95% CI, 0.71-0.91; P < .001).
Medicaid patients were more likely to return to the ED within 30 days (OR, 1.12; 95% CI, 1.03-1.22; P = .009) and within 180 days (OR, 1.48; 95% CI, 1.38-1.58; P < .001). But they were less likely to receive outpatient dermatology follow-up care within 30 days (OR, 0.12; 95% CI, 0.09-0.15; P < .001) and within 180 days (OR, 0.16; 95% CI, 0.14-0.18; P < .001).
“This study highlights potential areas of action to improve care for patients with HS,” the authors concluded, including cross-specialty education and interventions, and focus on patients most likely to return to the ED for care.