Telemedicine Considered Equivalent to In-Person Care for AD Follow-Up

Using telemedicine for the follow-up of patients with atopic dermatitis (AD) was as effective as in-person appointments, according to a review published in the Journal of Cutaneous Medicine and Surgery.¹

The researchers explained that, because of the COVID-19 pandemic, telemedicine emerged as a crucial tool in maintaining health care delivery as it reduced in-person consultations, minimized wait times, and enabled management and follow-up of chronic diseases. They noted that patients with AD require ongoing care to adjust and monitor treatment plans, prevent complications, and enhance quality of life. Consequently, the researchers hypothesized that telemedicine is a beneficial tool in managing AD.

The 3 primary methods for delivering teledermatologic care are asynchronous (store and forward), synchronous (live video or telephone evaluation), and hybrid (combination of the 2). The researchers explained that, because there are currently no evidence-based recommendations on the most effective approach, clinicians are using various telemedicine approaches and platforms to manage their patients with AD. Because of this, the researchers conducted a systemic review to assess current evidence on different telemedicine methods and evaluate outcomes for patients with AD.

Telemedicine | Image Credit: tippapatt - stock.adobe.com

To do so, the researchers created a list of telemedicine and AD keywords, and then a health sciences librarian conducted searches in MEDLINE, Scopus, Embase, and Cochrane trials on August 12, 2023. They included all studies from 1946 to August 11, 2023, that evaluated any telemedicine assessment for primary AD. Conversely, the researchers excluded studies that either did not evaluate these topics or involved other dermatologic conditions.

Two reviewers independently screened the titles and abstracts of retrieved studies to identify those potentially relevant. They then independently completed a full-text review using the predefined inclusion/exclusion criteria. The reviewers independently extracted data from included studies, including study characteristics, outcome measures, and the telemedicine model used.

After reviewing 2719 titles and abstracts, the researchers screened the full text of 108 studies. Of these, they excluded 103 studies as 82 did not describe a telemedicine model, 9 did not have full text available, and 12 did not include AD-specific data. Consequently, the researchers included 5 studies in their review, 4 being randomized controlled trials (RCTs) and 1 being a retrospective cohort study; they noted that all 5 used an asynchronous telemedicine model, but the implementation and outcome measures differed between each.

First, Armstrong et al used a patient-oriented eczema measure and investigator global assessment to compare the effectiveness of a direct-access online model with in-person office visits for the follow-up of dermatologic care in pediatric and adult patients with AD.² The authors found that patients who used the direct-access online model achieved equivalent improvements in disease severity compared with those who utilized in-person visits.

Similarly, Kornmehl et al used the Dermatology Life Quality Index, the 12-Item Short-Form Survey questionnaire, and the Children’s Dermatology Life Quality Index to assess the quality of life of patients with AD.³ They found that both adult and pediatric patients with AD who used telemedicine and those who were seen in person had equivalent quality-of-life outcomes.

Additionally, Bergmo et al assessed the effect of web-based consultations for parents of children with AD on health outcomes, self-management behaviors, health resources use, and family costs compared with standard treatment without specialist care.⁴ Their findings showed that web consultations are noninferior to standard treatment in terms of improving these respective factors.

Also, van Os-Medendorp et al compared the follow-up of patients with AD using an e-health portal with in-person follow-up.⁵ After initial diagnosis and treatment, they determined that telemedicine for patients with mild to moderate AD is as effective as face-to-face care in improving quality of life and disease severity. In terms of cost, their cost minimization analysis showed a 73% probability that telemedicine reduces indirect costs by reducing work absenteeism.

Lastly, a retrospective cohort study by Giavina-Bianchi et al evaluated the proportion of patients with AD who could be managed by their primary care provider with specialist telemedicine support, as well as the accuracy of AD diagnosis via an online portal and mobile application.⁶ Findings showed that primary care physicians managed 72% of patients with AD using telemedicine services, whereas 28% needed to be referred to in-person dermatologists. Additionally, the proportion of teledermatologists’ AD diagnoses that matched those made by the in-person dermatologist was 84.4%.

Overall, the analyzed studies demonstrated that using telemedicine for the follow-up of patients with AD is clinically effective and equivalent to in-person appointments.¹ On the other hand, due to the heterogeneity between the interventions studied, the researchers were unable to provide specific recommendations regarding the most effective modality. Other study constraints included the limited analysis of telemedicine benefits due to the small number of eligible papers. Based on these limitations, the researchers made suggestions for future research.

“Our team recommends that future cohorts conduct RCTs to determine which platforms are most effective for virtual assessment of AD,” the authors concluded.

References

1. Verma L, Turk T, Dennett L, Dytoc M. Teledermatology in atopic dermatitis: a systematic review. J Cutan Med Surg. doi:10.1177/12034754231223694
2. Armstrong AW, Johnson MA, Lin S, Maverakis E, Fazel N, Liu F-T. Patient-centered, direct-access online care for management of atopic dermatitis: a randomized clinical trial.JAMA Dermatol. 2015;151(2):154-160. doi:10.1001/jamadermatol.2014.2299
3. Kornmehl H, Singh S, Johnson MA, Armstrong AW. Direct-access online care for the management of atopic dermatitis: a randomized clinical trial examining patient quality of life. Telemed J E Health. 2017;23(9):726-732. doi:10.1089/tmj.2016.0249
4. Bergmo TS, Wangberg SC, Schopf TR, Solvoll T. Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trial. Acta Paediatr. 2009;98(2):316-320. doi:10.1111/j.1651-2227.2008.01033.x
5. van Os-Medendorp H, Koffijberg H, Eland-de Kok P, et al.E-health in caring for patients with atopic dermatitis: a randomized controlled cost-effectiveness study of internet-guided monitoring and online self-management training. Br J Dermatol. 2012;166(5):1060-1068. doi:10.1111/j.1365-2133.2012.10829.x
6. Giavina-Bianchi M, Giavina-Bianchi P, Santos AP, Rizzo LV, Cordioli E. Accuracy and efficiency of telemedicine in atopic dermatitis. JAAD Int. 2020;1(2):175-181. doi:10.1016/j.jdin.2020.08.002