Patient-Centered, Direct-Access Online Management of Atopic Dermatitis

Mary Wu Chang, MD

Provided patients have computer and camera access and literacy, online management may provide quality care to underserved communities.

Because of dermatologist shortages, teledermatology has been used in rural and underserved communities. Typically, the primary care provider sends patient information and images to the dermatologist, who then relays back information. This system is time-consuming, and dermatologic follow-up is problematic. Investigators performed a randomized, controlled equivalency study comparing a direct-access, asynchronous online model with in-person office visits for follow-up care of atopic dermatitis (AD).

One hundred fifty-six patients with moderate AD were recruited from primary care clinics. Inclusion criteria were Spanish- or English-speaking; patient age >4 years; and computer, Internet, and digital camera access and literacy. Patients receiving systemic treatments or needing laboratory monitoring were excluded. Four dermatologists provided patient care, and a fifth blinded to patient randomization performed Investigator's Global Assessment (IGA) evaluation of digital images.

At the initial office visit, patients were photographed, received Patient-Oriented Eczema Measure (POEM) and IGA scores as well as a treatment plan, and were then randomized to online management or in-person care (controls). All patients were taught how to photograph and submit standardized global and close-up lesional photographs via the website. The control group had six in-person dermatology visits every 2 months. The online group had six online asynchronous visits with a dermatologist every 2 months. POEM and IGA scores and photographs were assessed at each visit. The drop-out rate was very low. Both groups improved significantly in all parameters. At 12 months, POEM scores had decreased by 5.1 in the online group and 4.86 in the control group. The authors conclude that at 1 year, the online model yielded AD outcomes equivalent to traditional office visits.

Citation(s):

Armstrong AW et al. Patient-centered, direct-access online care for management of atopic dermatitis: A randomized clinical trial. JAMA Dermatol 2014 Oct 22; [e-pub ahead of print].