ALBUQUERQUE – Children and adults with atopic dermatitis had similar improvements in symptoms whether they received follow-up care through direct access to physicians online or in person, according to a 12-month randomized trial.
The mean decrease in scores on the patient-oriented eczema measure (POEM) was –5.1 for patients who received follow-up care from a dermatologist online, compared with –4.86 for those who received care in person, said Dr. April Armstrong.
"We’re looking at models that can essentially work for delivery of dermatology care anywhere, anytime," said Dr. Armstrong, vice chair of clinical research and associate professor of dermatology at the University of Colorado in Aurora. "From patients’ perspectives, they may be willing to pay out of pocket in return for expedited care without traveling, waiting, or missing work or school."
Dr. April W. Armstrong
Dr. Armstrong presented the study findings at the annual meeting of the Society for Investigative Dermatology. Her interest in online care was sparked by patients’ lack of access to dermatologists and younger patients’ acceptance of and comfort with technology, she said.
She and her associates randomized 156 children (aged at least 4 years) and adults with atopic dermatitis to receive 12 months of follow-up care from dermatologists either in person or online. The online group took high-quality photographs of their skin lesions and sent the images and clinical data to dermatologists at the University of California, Davis, who provided asynchronous evaluations, made recommendations, and e-prescribed medications as needed. The second group received in-person care from the UC Davis dermatologists.
At 12 months, the difference in mean POEM scores between the two groups was 0.24, and the 95% confidence interval of –1.8-2.2 fell within the prespecified equivalence margin of 3, said Dr. Armstrong. Therefore, the results supported rejecting the null hypothesis that the care models had different effects, she said. The POEM assessment focuses primarily on symptom morbidity, and scores have been shown to correlate with the Eczema Area and Severity Index (EASI) and the SCORAD (scoring atopic dermatitis) Index, Dr. Armstrong said.
In addition, the researchers observed "clinically meaningful" improvements in both groups’ scores on the Dermatology Life Quality Index (DLQI) and the Children’s Dermatology Life Quality Index (CDLQI), with all mean improvements greater than 5, said Dr. Armstrong.
The groups did not differ significantly in terms of baseline characteristics, said Dr. Armstrong. There was a 10% dropout rate overall, with similar rates of loss to follow up between the two groups, she said. The groups also did not differ in terms of adverse effects from medications, she added.
The findings suggest that direct-access online follow-up care may be a reasonable option for children and adults with atopic dermatitis, Dr. Armstrong said. "The key questions are which diseases are suitable, which patients are suitable, and what the regulatory and consumer issues are," she added. "We want to tailor our delivery approach to our healthcare consumers."
The Agency for Healthcare Research and Quality funded the study. Dr. Armstrong reported no conflicts of interest.