Experts Discuss Improving Access to Dermatology Care

In an interview with Pharmacy Times, Muneeb Shah, DO, dermatologist and partner at PC Dermatology PLLC, and Reid Maclellan, MD, founder of Cortina Health Inc, discuss accessible health care in the dermatology landscape. They also touch on what role technology plays in health care education.

SNAB - stock.adobe.com

Q: This partnership between Dr. Shah and Cortina is designed to improve access to dermatology care, and our audience of pharmacists may not have thought much before about dermatology access. Can you discuss what those access obstacles are and why this access is important?

Reid Maclellan: Absolutely, and maybe I'll jump in first, but I think Dr. Shaw is going to have a lot to say about it as well. In dermatology, specifically as a specialty. These guys and girls are working every single day, but the problem is there's a supply and demand issue. There's a lot of individuals in United States that need to be seen by a board-certified dermatologist to really be diagnosed and prescribe exactly what they need for their individual treatment. Unfortunately, the average wait time can be anywhere between 1 to 2, sometimes in middle America up to 6 months, to be seen in person for a dermatology disease. At Cortina Health, we decided that we really wanted to democratize dermatology care. We wanted to be able to give access to everyone, but access isn't just that you can log on and see it. It's also affordability at the end of the day. We worked out a way of being able to really provide that in all 50 states right now with a strictly US board-certified dermatologist.

Muneeb Shah: There is, seen from the front lines from my office itself, it's very difficult to get in health care can be very expensive. Some people don't have insurance, they can't afford the copay, they haven't met the deductible, that's just for the visit alone, and then you send them to the pharmacy to get 3 or 4 prescriptions just to treat 1 condition. For example, rosacea would be a really good option for this as an example, is a lot of times we're using 2 or 3 medications, somewhat mixed together that are individually going to cost you anywhere from $40 to $100 per treatment. That's very, very expensive for the patient. So not only is it difficult to get in to see a dermatologist, some people just can't even afford to 1. see the dermatologist and then 2. pick up the medications.

Cortina gives, you know that flat rate fee, monthly subscription, the compounding a bunch of different ingredients into 1 formula, so you're not getting 3 or 4 prescriptions to treat 1 condition, and then giving you 24-hour access to a dermatologist were, one of the things that I see in the office, is that we have patients that are parents, and they can't get in to see you at between like 8 and 5 because they're at work, and then they have to take their kid to soccer practice or something like this. They just don't even have the time to come in to see a dermatologist. These this increased access just improves patient care across the board.

Q: Technology, online spaces, and social media could be huge tools to improve health care education. Can you discuss the role of this technology and social media in improving health care and dermatology access?

Muneeb Shah: Using social medias is somewhat my thing, basically, prior to, I would say the last 3 years, there was not a lot of great information online about dermatology or other health professions. Then having access to these tools, YouTube, TikTok, Instagram, you're really allowing that education to reach anyone in any part of the world. A lot of people see it as US centric, but I have half my followers are outside of the United States. I have patients Indonesia, Malaysia that are learning detailed information on how to treat acne, melasma, rosacea, hair loss, and that information is free and publicly available for them to consume and improve their skin. One of the things I think was great about Cortina, for me, was that I have this large audience, especially all over the United States, that I'm teaching them how to take care of their skin, and then Corina, it gives them the access to the actual treatments that you need to improve your skin. That partnership sort of made sense for me. Education can change the world. I've seen it happen in real time. Over the last 3 years, my patients who I've never met before, when they come into the office, their education on the skin is 10 times better than it was prior to the last 3 years.

Reid Maclellan: One of the main reasons we wanted to partner with Dr. Shah and his social media audience was the fact that he is the number 1 dermatology educator in the world actually. We knew as we have our Cortina patients coming to us, our dermatologists are educating them every single day, but we also needed to have really concise content that explained exactly what each of the skin diseases were treating as well as, Dr. Shah mentioned before, we compound all of our formulations so we add lots of different active ingredients together as one, so we want to be able to educate the patient on why we're doing that because a lot of patients have never received a compounded medication before and so having Dr. Shah just be that advisor to us to really explain this is exactly how we're going to communicate this piece or that piece has been great.

What’s also been great is that we've been an outlet for him to finally be able to say to his audience, if you need to go see a dermatologist and you can’t get in to see one in person, you can go to get Cortina.com right now and within 24 hours a board-certified dermatologist will not only have reviewed your case you will actually have been diagnosed communicated with that [physician] and received that personalized prescription view.

Q: As we saw during the COVID-19 pandemic, social media can also be a space where health care misinformation spreads rapidly. How do you think about this issue and tackle it online?

Muneeb Shah: We know that misinformation is always compelling, and people believe it, and then it spreads rapidly out of our control. In the past, there was not a lot of health care providers on social media, and so that misinformation would often spread unchecked at that rate. By creating content and debunking this misinformation, where the misinformation starts, which is I think, really important context here is that people are spreading misinformation on TikTok, they’re spreading misinformation on Instagram, Facebook, YouTube.

Then we counteract, historically, that misinformation in other sources of media, the Wall Street Journal, the New York Times is covering this misinformation, “Hey, this isn't good information. You shouldn't be doing this.” But the person on Tik Tok is not going to check their references on the in the New York Times. So debunking misinformation on social media, where the misinformation starts, is the only way to debunk that information. Now we're out here trying to counteract that misinformation that's moving so quickly. We need 6 times as many doctors on social media that we have today, just because we know that misinformation travels 6 times as fast. I can't just be me, one of the pieces in the puzzle, but we need more doctors creating good information on social media to counteract the misinformation.

Q: Pharmacists are the most accessible health care providers in the US. How can they play a role in improving this access to dermatology care?

Muneeb Shah: One of the things with you know, pharmacies, one for Cortina in general, we work directly with pharmacists to compound these medications, so that they can reach patients without pharmacists, this whole model doesn't even work. You have the technology that Cortina is built to make the platform accessible. You have the board-certified dermatologists, which are a very important part of this equation that are making the diagnosis and picking the treatment plan. Then you have the pharmacists that’s delivering that medication to the patient. Everyone is really important in that process. I think, traditionally, when we refer patients to go pick up a medication, a lot of the education on those medications happen at that point of sale. Our pharmacy colleagues are super important in educating our patients, talking to them about medications that they're already on, how they may interact together, how to use those medications, how to how to even improve access to those medications at times, through getting [and] using different coupons and codes and loyalty plans and reward plans that just get discounts on their medication. Pharmacists, like you said, they're probably one of the health care providers that patients come in most contact with, and so they're very important in this whole process to Cortina and me, just as a practicing dermatologist.

Reid Maclellan: We leverage our Cortina pharmacist every single day to interact directly with the patient, because as Dr. Shah mentioned, we're prescribing a lot of different combinations of medications, and they may react a little differently with each patient, maybe the patient use too little, or maybe the patient used too much of a topical form. A lot of times we've seen this, that of course, a patient can always come to back to their doctor at Cortina to talk to the doctor and ask the question, but they really reach out to the pharmacist because it's the medication that they're using. They say, “is this am I supposed to feel this way or not?” So the pharmacist being able to really educate the patient on exactly what the treatments that the patient is going to about to put on their skin or put in their body, as well as what you could potentially expect from that the “yes, this is normal” or “no, this actually isn't normal. Let's reach out to the doctor and talk more about it” is so important for the access.

Muneeb Shah: I definitely want to highlight a few things about Cortina that made me want to be an advisor and partner of the company. One of those things is that they exclusively use board-certified dermatologists for the sort of prescription part and the diagnosis part, which to me is critical, because it's very difficult to make a diagnosis through a 2d image, which is how these tele-dermatology platforms work is that you're getting limited information in terms of a picture. They're using technology to speed up that process to make it affordable to be able to do that. Then just increasing accessibility for my patients, but where I see this type of platform existing is you have the over-the-counter space, which actually pharmacy plays a big role in this, is like you walk into CVS and you have the products that over the counter and a lot of times the pharmacist is saying, “Hey, this is a great acne treatment, but it's not a prescription.” Then you could go see a dermatologist, which I always say is the gold standard. In between this space is a lot of people and a lack of access between these 2 over the counter and the gold standard: seeing a dermatologist in person. Cortina really solves that problem and so I really just want to get the message out that this platform exists so patient can have access to that care.