BH23 Mind the gap! Navigating barriers to care access for patients with alopecia areata in the UK: a qualitative interview study

Abstract Alopecia areata (AA) is a chronic inflammatory disease that affects hair follicles and is associated with significant psychosocial comorbidities, impacting patient quality of life. AA is currently underprioritized by health services, leading to disparities in care across the UK. It is important to understand how current care and management are delivered to effect change. The study aimed to identify and understand challenges that UK patients with AA face when accessing healthcare and to explore potential solutions to support patients. Virtual qualitative interviews were conducted with 10 key stakeholders: seven secondary or tertiary care healthcare professionals (HCPs; four consultant dermatologists and three pharmacists) and three patients with AA. Using focused open-ended questions, the interviews extracted data on individual practice views and challenges, while exploring factors potentially impacting patient care (e.g. disease awareness, funding and resources). Stakeholder discussions confirmed there is no consistent AA care pathway for patients in the UK. All three patients and five of the seven HCPs highlighted a need for greater education regarding AA treatment, with an emphasis on education for general practitioners (GPs). HCPs and patients described that in most cases GP referral to secondary care was required before referral to specialist hair clinics. All stakeholders reported substantial waiting times for secondary care appointments (12–18 months), with additional waits for specialist hair clinics. All HCPs cited lack of clinical capacity for prolonged waiting times. Furthermore, specialist hair clinics were not widely available, with two of three patients having to travel long distances to attend. All seven HCPs stated challenges limiting patient access to new therapies, including administrative burden (Blueteq forms, funding requests, developing treatment pathways and managing homecare). All four dermatologists reported insufficient staffing to undertake mandatory baseline assessment and medication monitoring for new treatments. This UK landscape exploration of AA care identified current key challenges of poorly defined care pathways, need for GP education, long waiting times, lack of hair specialist access, and lack of funding and resources limiting access to emerging treatments. Important work is needed to optimize AA care pathways to improve patient journeys and enhance outcomes. The interview findings have been incorporated into an ongoing Delphi questionnaire (three rounds with 100 HCPs), with the final responses being scrutinized by an expert steering committee of AA stakeholders to develop a consensus on AA management and robust patient care pathways. Pfizer sponsored and funded this work.