Direct-access online care model may effectively manage chronic atopic dermatitis

1. When compared to an in-person visit, management of atopic dermatitis via an online care model had similar outcomes.

Evidence Rating Level: 2 (Good)

Study Rundown: Limited access to dermatologic care in select regions has led to the rise of a variety of models for improved access. Teledermatology, the process of communicating dermatologic information electronically, may be able to meet this need. In this study, authors sought to assess the effectiveness of a direct-access online model as compared to an in-person model for the management of atopic dermatitis. Using two metrics looking at disease severity, the authors showed comparable improvement in outcomes for both the in-person and online-care groups. The study’s strength was its randomized control trial design; however, the generalizability was limited as this was a relatively small study that looked at patients with only one chronic skin disease with similar burden of disease.

Click to read the study in JAMA Dermatology

Relevant Reading: Care Partners and Online Patient Portals

In-Depth [randomized controlled trial]: A total of 156 pediatric and adult patients with atopic dermatitis were selected for randomization into either an in-patient or direct-access online group. The patient-oriented eczema measure (POEM) and investigator global assessment (IGA) were used as metrics to assess atopic dermatitis severity. The average age of the direct-access online group and in-person group was comparable at 27.4 and 28, respectively. Using IGA scores, the direct-access online group showed 38.4% (95% CI, 27.7% to 49.3%) of patients achieved near-clearance of their disease as compared to 43.65% (95% CI, 32.6%-54.6%) in the in-person group. The POEM metric demonstrated that the direct-access online group’s scores improved by month 12 from a mean baseline of 13.04 to 7.94 (within group difference of -5.1) as compared to 12.71 to 7.85 (within group difference of -4.86) of the in-person group. The difference in the change in mean POEM scores between the two groups was 0.24 (within the 90% CI of -1.70 – 1.23) indicating that the two interventions met the standards for equivalence.

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Image: PD

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