Atopic Dermatitis: Online Follow-up Effective
Jenni Laidman
Online communication with a dermatologist for follow-up treatment of atopic dermatitis proved just as effective as in-person patient visits, according to a study published online October 22 in JAMA Dermatology.
April W. Armstrong, MD, MPH, associate professor of dermatology and vice chair of clinical research, Department of Dermatology, University of Colorado, Denver, and colleagues randomly assigned 156 children, aged 4 years and older, and adults with atopic dermatitis to receive online or in-person care after an initial in-person visit. Both groups had contact with a dermatologist six times at 2-month intervals. All participants submitted digital photographs of their skin throughout the study.
In the online group, physicians managed patient care by evaluating information and photographs provided by patients online and made recommendations, offered education, and wrote prescriptions. The 78 patients in the in-person group had a mean age of 28.0 years (standard deviation [SD], 9.9 years) and visited dermatologists in their offices for follow-up care. The mean age of the online group was 27.4 years (SD, 10.1 years).
Treatment success was assessed by patient-oriented eczema measure (POEM) and investigator global assessment after a year. The difference in the change in POEM scores between the two groups was not significant, at 0.24 (SD, 6.59; 95% confidence interval [CI], −1.70 to 1.23).
Specifically, patients in the online group saw POEM scores improve from a mean baseline of 13.04 (SD, 5.32) to 4.55 at 12 months, a within-group difference of −5.1 (SD, 5.48; 95% CI, −6.32 to −3.88). In the in-person group, POEM scores improved from a baseline of 12.71 (SD, 5.58) to 7.85 (SD, 4.44) at 12 months, a within-group difference of −4.86 (SD, 4.87; 95% CI, −6.27 to −3.46) for the in-person group.
In the online-access group, 38.4% of patients (95% CI, 27.7% - 49.3%) achieved clearance or near-clearance of disease compared with 43.6% (95% CI, 32.6% - 54.6%) in the in-person group. The difference between the two groups in achieving clearance or near clearance was 5.1% (90% CI, 1.7% - 8.6%), which is within the predetermined 10% equivalence margin.
"In this randomized controlled equivalency clinical trial, we found that patients whose disease was managed through the direct-access online model achieved equivalent improvements in atopic dermatitis disease severity compared with those whose disease was managed through the usual, in-person visits," the authors write.
Online access could provide an important avenue of care, especially in underserved areas, the authors write. Lack of access in some communities can lead to "poor clinical outcomes and considerable impairment in quality of life," they add.
The research was supported by an Agency for Healthcare Quality and Research award. The authors have disclosed no relevant financial relationships.
JAMA Dermatol. Published online October 22, 2014. Full text