Bringing pharmacists, allergists and dermatologists together to discuss patient care can improve outcomes for children with atopic dermatitis, researchers said.
“I think we got a real insight into how a more holistic approach benefited the patient,” said Lawrence Eichenfield, MD, professor of dermatology and pediatrics at the University of California, San Diego (UCSD), in an interview.
At the 2021 International Society of Atopic Dermatitis (ISAD) annual meeting, he and his colleagues described a pilot program to bring together the specialists from UCSD and Rady Children’s Hospital, San Diego, California.
Typically, children seeking care for atopic dermatitis see allergists and dermatologists separately for 10 to 15 minute appointments. The specialists sometimes prescribe treatments that conflict with each other or are unnecessary and may give conflicting instructions.
Instead, Eichenfield and colleagues designed a program that brought in patients for 1 to 1.5 hour initial assessments. Patients usually began with visits to a clinical pharmacist, who assessed which drugs had been prescribed and how much the patients were actually taking.
The patients then went to an allergist or dermatologist for evaluation. These specialists then met in person to develop a treatment plan. At least one of the specialists would then present the plan to the patient and the patient’s family.
“We had a rich set of educational materials that were developed and posted online that helped make shared decisions and be more comfortable with the right skin care and medication,” said Eichenfield.
He and his colleagues appointed a physician assistant trained in both pediatric dermatology and pediatric allergy to coordinate the clinic. They designed combined pediatric dermatology and pediatric allergy grants for two fellows. “So part of this program ended up admitting specially trained individuals who overlapped each other in fields that were traditionally separate,” said Eichenfield.
To see how well the approach worked, the researchers tracked the progress of 23 patients already undergoing treatment at one or both institutions.
Eczema Area and Severity Index (EASI) scores decreased from visit 1 to visit 2 by an average of 15.36 (p <0.001), which corresponds to a mean decrease of 56.36%.
In 20 patients (89.96%) the EASI scores improved by 50% (EASI-50).
Thirteen patients (56.54%) achieved 75% improvement in EASI scores (EASI-75).
Body surface scores improved by an average of 23.21% (P = .002).
Validated Investigator Global Assessment scores decreased to a clinically significant level in 56.52% of patients.
The study did not include any control group, nor did the researchers report details on how long the patients had been treated before the multidisciplinary program started or how their prescriptions changed.
Patients benefited from the comprehensive assessment of their symptoms, said Eichenfield, also chief of pediatric and adolescent dermatology at Rady Children’s Hospital, San Diego. “Some had significant environmental allergies that may not have contributed to their atopic dermatitis,” he explained. “The complexity of co-morbidity and atopic dermatitis affects the patient, even if one condition is not necessarily the direct cause of another.”
In surveys, patients said they especially appreciated the increased time they spent with their specialists. “No one ever taught us about eczema for an hour,” some noted. The approach motivated patients to perform their home treatment more effectively, Eichenfield believes.
Primary care physicians did not participate in the multidisciplinary program, but the specialists communicated with them and shared electronic medical records with them, he said.
Without a control group, it’s hard to say how much of a difference the multidisciplinary approach has made, Jonathan I. Silverberg, MD, PhD, MPH, associate professor of dermatology and director of clinical research and contact dermatitis at George Washington University, Washington, DC, said in an interview.
“What it does show is that within this multidisciplinary approach there is significant improvement in a number of endpoints,” Silverberg said in an interview. “And so I have no doubt that this is valid and that a multidisciplinary approach would holistically improve many aspects of patient care.”
Silverberg led a multidisciplinary program at Northwestern University in Chicago that included sleep medicine, endocrinology, gastroenterology, and other specialties, as well as dermatology, allergy, and pharmacy.
However, Silverberg pointed out that a multidisciplinary approach is more expensive than standard care because when specialists spend more time with each patient, they see fewer patients per day. “So many health care systems or academic institutions are not as open as they should be to this type of interdisciplinary care, which is why it is so important to have outcome measures that show that this approach really works.”
Annual Meeting of the International Society of Atopic Dermatitis (ISAD) 2021. Summary PT29. Presented April 19, 2021.
Laird Harrison writes about science, health and culture. His work has appeared in national magazines, in newspapers, on public radio and on websites. He is working on a novel about alternative realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at www. lairdharrison.com or follow him on Twitter: @LairdH
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