April W Armstrong, Alyssa M Roberts, Gina Kostandy, Farzana Choudhury, Danielle Yee, Minnelly Luu, Madison E Jones, Elmar R Alizadeh, Jonathan Cotliar, Mary-Margaret Chren, Joel M Gelfand, Myles Cockburn, Jason N Doctor
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引用次数: 0
Abstract
Importance: Accessible and effective management of atopic dermatitis (AD) across geographic boundaries is important. Scalable, collaborative care models that integrate patients, primary care practitioners, and specialists remain an unmet need.
Objective: To determine whether an online, team-based connected health (TCH) model provides equivalent improvements in AD severity compared to in-person care.
Design, setting, and participants: In this pragmatic, randomized clinical equivalence trial, 300 patients with AD were enrolled from 8 outpatient dermatology clinics in California from August 2019 to May 2024 and randomized 1:1 to online or in-person care. Eligible participants were at least 1 year old and had a physician diagnosis of AD, internet and photograph access, and established or new clinician care.
Intervention: The TCH model provided asynchronous, online access to dermatologists. Dermatologists reviewed patients' clinical histories and photographs and provided assessments and treatment recommendations online. The control arm provided conventional, in-person care.
Main outcomes and measures: The primary outcome was 12-month change in the EASI (Eczema Area and Severity Index); secondary outcomes were changes in the POEM (Patient-Oriented Eczema Measure) and validated vIGA (Investigator Global Assessment), assessed quarterly.
Results: Among 300 adults and children with AD (mean [SD] age, 34.6 [17.7] years; 211 [70.3%] female), 149 were assigned to TCH and 151 to in-person care. The difference in mean change between the 2 groups was -0.01 (95% CI, -0.22 to 0.20) for the EASI, 0.38 (95% CI, 0.03-0.73) for the POEM, and 0.06 (95% CI, 0.00-0.11) for the vIGA. All differences fell within prespecified equivalence margins.
Conclusions and relevance: In this randomized clinical trial, the online TCH model resulted in equivalent improvements in AD signs and symptoms compared to in-person care. Telehealth models may serve as effective tools for managing chronic diseases like AD.
期刊介绍：
JAMA Dermatology is an international peer-reviewed journal that has been in continuous publication since 1882. It began publication by the American Medical Association in 1920 as Archives of Dermatology and Syphilology. The journal publishes material that helps in the development and testing of the effectiveness of diagnosis and treatment in medical and surgical dermatology, pediatric and geriatric dermatology, and oncologic and aesthetic dermatologic surgery.
JAMA Dermatology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications. It is published online weekly, every Wednesday, and in 12 print/online issues a year. The mission of the journal is to elevate the art and science of health and diseases of skin, hair, nails, and mucous membranes, and their treatment, with the aim of enabling dermatologists to deliver evidence-based, high-value medical and surgical dermatologic care.
The journal publishes a broad range of innovative studies and trials that shift research and clinical practice paradigms, expand the understanding of the burden of dermatologic diseases and key outcomes, improve the practice of dermatology, and ensure equitable care to all patients. It also features research and opinion examining ethical, moral, socioeconomic, educational, and political issues relevant to dermatologists, aiming to enable ongoing improvement to the workforce, scope of practice, and the training of future dermatologists.
JAMA Dermatology aims to be a leader in developing initiatives to improve diversity, equity, and inclusion within the specialty and within dermatology medical publishing.
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