Ginette Okoye, MD: Disparities in Care for Patients with Hidradenitis Suppurativa

During her interview with the HCPLive editorial team, Ginette Okoye, MD, spoke about some of the biggest takeaways from her talk presented at the 8th annual Symposium on Hidradenitis Suppurativa Advances (SHSA) Conference on October 13 -15.

Okoye is known for her work as professor and chair of dermatology at Howard University College of Medicine in Washington, DC.

In her interview, Okoye addressed the topic of treating hidradenitis suppurativa (HS) patients, potential disparities in healthcare for such patients, and ways to support underserved communities.

“You know, I think the most important impact is the fact that patients don't have adequate access to dermatologists,” Okoye said. “You know, there are places in the US where there are no dermatologists for miles and miles and patients have to drive hours to find us, even in patient places where dermatologists are accessible. Sometimes we don't take every insurance type. And we know that our patients with HS are more likely to have a low socioeconomic status, and so they're more likely to have public insurance.”

Given this lack of access, Okoye explained that such HS patients often do not get to meet with a dermatologist until quite late in the course of their disease. She added that they are actually more likely to see other types of providers initially, such as surgeons or inpatient services.

“I think it starts at the very top of our organization with the American Academy of Dermatology and other organizations just really pushing advocacy at the highest levels to improve access to care,” Okoye said. “So things like improving reimbursement for seeing patients with public insurance to incentivize more physicians and other providers to see patients with Medicaid. I think that's a pretty high level, pie-in-the-sky wish of mine. But I think that would help. I think it's important for us as dermatology providers who are interested in HS and know quite a bit about it to really educate our colleagues and non-dermatology colleagues who might see our patients.”

She explained that this could include OB-GYNs, emergency department doctors, and surgeons. Okoye noted that teaching them about HS and creating a referral pathway which is easy to a non-dermatologist is useful, so that HS patients can get care sooner.

Okoye was also asked about notable differences in the prevalence or severity of HS among various demographic groups.

“So HS is more common in people of African descent in the US, among adults, adolescents and children,” Okoye explained. “So sort of throughout the lifespan. It's more common in women. But I have to say when I see HS men, it tends to be more severe. And there's some emerging data about HS and our Hispanic patients also suggesting that it's more severe in Hispanic patients, and they're more likely to end up in the hospital because of their HS.”

Okoye also noted that social determinants of health tend to impact these differences in patient care and overall access.

“But another issue from my perspective is access to medications as well,” she said. So there are patients who might get the right diagnosis, but then don't have access to some of the biologics. They don't have access to a surgeon who is specifically interested in HS and so they know what they have, but they're not able to get the medications. For me, this is a huge problem for me and the patient population. Not getting the medication sometimes is just related to their socioeconomic status, their living situation.”

Okoye also explained that it may be difficult for such patients to keep their medications safely in a refrigerated setting.

“These are issues that, I guess throughout my career I’ve thought about and I thought I knew,” she said. “But it took really talking to patients and getting a sense for their day to day struggles to realize how much we take for granted when we prescribe a medication.”

The quotes contained here were edited for clarity.