Improving Health Outcomes Through Community Outreach

Fotios Koumpouras, MD, associate professor of medicine (rheumatology), and Sarika Ramachandran, MD, associate professor of dermatology, are cofounders of the Yale School of Medicine’s combined rheumatology/dermatology clinic, which treats patients with lupus and other rheumatic and dermatologic diseases. Often patients are referred to the clinic after they have tried standard treatments without success.

In a conversation, Koumpouras and Ramachandran discuss the goals of the clinic, including increasing awareness about lupus and other complex and sometimes hidden diseases, addressing barriers to clinical trial participation, and forging connections with people in the local community.

FK: Collaborative clinics and centers of excellence are an optimal way to treat complex, multi-system diseases. Connective tissue diseases often affect the skin and internal organs, so patients are best served by a clinic where both specialists come together to make a diagnosis and manage the condition. In our clinic, we examine patients at the same time which allows us to consolidate care to achieve a more rapid diagnosis and effective management plan.

SR: After we both joined Yale in 2015, there was a concerted effort to bring our expertise together. The clinic allows us to work collaboratively, and one of our initiatives is a rheumatology dermatology conference, which brings together faculty, fellows, and residents from both departments to discuss complicated patient cases at length. It’s exciting to have experts from different disciplines together in the same room. As we review these cases, we highlight important findings and learn from each other. We’ve also invited thought leaders to come to Yale to discuss their research.

FK: Lupus disproportionately affects certain ethnic groups, including African Americans, East Asians, and Hispanics. Community outreach helps to provide education and increase awareness, as people with lupus often have fears about treatments and the stigma inappropriately associated with the diagnosis. Since lupus often occurs in young people, access to health care can also be difficult. The pandemic has shown us that you need community outreach to improve outcomes.

SR: There has been a disconnect between the diverse people affected by lupus and the people entering lupus clinical trials. When we started the clinic, we wanted to address some of the barriers to clinical trial participation, particularly in lupus clinical trials, such as access, opportunity, mistrust, health literacy, and cultural aspects. Our goal in the past few years has been to address each of these in different ways.

SR: Raising awareness through community engagement can help people feel comfortable joining clinical trials or receiving therapeutic regimens. It is critical that patients feel that their health care providers understand them. When patients feel connected to their care and when they're able to meet with physicians they trust, they have better health outcomes.

FK: Involving the community can help raise awareness of diseases, address unmet needs, increase funding by government or local sources, and improve the understanding that general access to health care is an important part of living.

SR: These efforts benefit physicians in many ways, including increasing participation in clinical trials to include a diverse set of patients impacted by the disease. This gives us a better understanding of how the disease is behaving and how patients who are most affected by it are responding to therapies. It’s also important for our trainees to learn how to engage with patients from various backgrounds.

FK: Our clinic also focuses on therapeutic dilemmas. We are able to utilize our collective expertise to provide personalized treatment plans, including access to novel, promising treatments in our clinical trials program. Our clinical trial portfolio addresses unmet needs in lupus, including skin disease, renal disease, and brain fog.

FK: The effort we place on outreach translates into additional funding to help expand access at the level of both the clinic and clinical research, with the ultimate goal of improving the care of patients with lupus and finding a cure. Examples of our outreach activities include regional fundraisers and educational forums, such as the New Haven Free Public Library empowerment workshop. We interact with community leaders to help increase exposure of the disease as well as our clinic and research program.

We also have a trials buddy program, a new initiative in which we pair someone who is interested in learning more about clinical trials with someone who has participated in one. They meet quarterly, either by phone or video. This is an opportunity for someone to do one-to-one outreach and talk about their condition, how their medications are impacting them, for example, and the experience of being in a research trial.

We’re fortunate that Connecticut’s small geographic size gives us an opportunity to have impactful outreach across vast communities at risk for rheumatologic-dermatologic disease. We can raise community awareness about new treatment options and the expertise that now exists at Yale Medicine to tackle these disorders while advancing the state of the art using clinical trials to further the discovery of new, safer, more effective therapies.

SR: We will also be rolling out a free cutaneous lupus support group for the local community. We provide free skin cancer screenings, which are relevant to some of our lupus and other patients who are immunosuppressed. We focus on patients who are underhoused and poorly insured, and we’ve distributed basic skincare products to shelters. We plan to expand our outreach even more, including to the refugee population of New Haven, to get patients engaged and involved.

We’re also joining national organizations and not just looking at equity right here in our community, which is our focus, but also seeing what other institutions are doing and how we can use similar strategies.

We hope that our clinic gets newer physicians excited about outreach so that this connection with the community continues for future generations.

Yale School of Medicine’s Department of Internal Medicine Section of Rheumatology, Allergy and Immunology is dedicated to providing care for patients with rheumatic, allergic and immunologic disorders; educating future generations of thought leaders in the field; and conducting research into fundamental questions of autoimmunity and immunology. To learn more about their work, visit Rheumatology, Allergy & Immunology.

The Department of Dermatology at Yale School of Medicine is committed to advancing the field of dermatology through cutting-edge research, field-leading education, clinical innovation, and exceptional patient care.