Patient-Centered Online Care Model for Follow-Up Management of Atopic Dermatitis

In the United States, there is an inadequate supply of dermatologists to meet the demand for dermatologic services, especially in underserved communities. As a result, patients with chronic skin diseases such as atopic dermatitis, who lack access to regular dermatologic care, experience poor clinical outcomes and significant impairment in quality of life. Studies suggest that teledermatology presents an opportunity to improve access to dermatological specialist care. Store-and-forward teledermatology is defined as the practice of dermatology through digital capturing and transmission of clinical images and patient history, followed by asynchronous evaluation of the clinical information by a dermatologist. The diagnostic accuracy and reliability of store-and-forward teledermatology have been studied and found to be relatively comparable to those of face-to-face care. However, few studies have examined its impact on clinical outcomes.

The objective of this study was to compare effectiveness of patient-accessed teledermatology with in-person office visits for followup management of atopic dermatitis. The investigators tested the hypothesis that patients with atopic dermatitis managed through the direct-access online model would have equivalent improvement in their disease severity as those managed in person.

The investigators performed a 1-year, randomized controlled equivalency clinical trial in medically underserved areas, outpatient clinics, and the general community. The participants included children and adults with atopic dermatitis with access to the Internet, a computer, and a digital camera. After an initial in-person visit, patients were randomized 1:1 to direct-access online or usual in-person care for followup management of atopic dermatitis. In the online group, patients captured and transmitted clinical images and history asynchronously to dermatologists online. Dermatologists then evaluated the clinical information, provided recommendations and education, and prescribed medications online asynchronously. In the in-person group, patients visited dermatologists in their offices for routine followup care.

A total of 156 children and adults were randomized to either online or in-person care for followup management of atopic dermatitis. The investigators found that improvements in atopic dermatitis clinical outcomes, as measured by the Patient Oriented Eczema Measure and Investigator Global Assessment, were comparable between the two groups. Thus, this study showed that direct-access online care may represent an innovative model of delivering dermatological services to patients with chronic skin diseases.