Increased Communication, Education Strategies Aid In Diagnosis of Atopic Dermatitis

Stephan Weidinger, MD

Due to the frequent misdiagnosis and undertreatment of atopic dermatitis (AD), the launch of the Atopic Dermatitis Quality of Care Initiative set out to investigate barriers in care and find good practice interventions to improve care worldwide.

Led by Stephan Weidinger, MD, Department of Dermatology, University Hospital Schleswig-Holstein, a team of investigators reviewed the literature of the initiative in order to define the challenges in atopic dermatitis, as well as a survey of 32 centers to better define good practice interventions.

The initiative observed the specialty centers on atopic dermatitis implemented strategies to improve diagnosis and severity assessment, including increasing communication between patient and caregiver, as well as providing education on the condition.

Methods

The study included the 32 worldwide centers considered experts in the treatment of atopic dermatitis, who were selected based on experience, research, and contribution to guidelines. Sizes of the centers were defined by the number of patients cared for and the size of the team.

Additionally, the centers were surveyed to determine the good practice implementations used to address challenges identified in the literature review and site survey. The questions were targeted to identify interventions used to overcome challenges with clinical assessment and diagnosis of atopic dermatitis, including awareness of atopic dermatitis, and delays in screening, diagnosis, and referral.

Those involved in the care of atopic dermatitis were interviewed, including dermatologists, practice extenders, and comorbidity specialists. Investigators visited each site during the 2-day survey that included an open field category and a tour.

Findings

Primary gaps in clinical assessments of atopic dermatitis included difficulty differentiating the condition from mimics, diagnosing atypical atopic dermatitis, and staging atopic dermatitis severity/activity in individual patients.

The survey of the sites showed that most patients were initially diagnosed by their primary care physician (PCP), who were considered to have less atopic dermatitis experience. Data show an average referral from the PCP to the atopic dermatitis center at 1.9 months.

Goals of good practice interventions for clinical assessment and diagnosis of atopic dermatitis was to reduce delays in access to care. Moreover, patient-centered goals consisted of avoiding unnecessary deterioration in the patient’s condition and enabling patient autonomy with shared decision-making.

Implementations in the study were divided into easy resource-sparing implementation, moderately complex, and advanced. The easy implementation included a clinical history and examination to rule out other complications, while the moderate included the use of diagnostic tools. Then, the advanced implementations included the use of diagnostic criteria, as well as outcome assessments using validated instruments.

Data show initial assessments of atopic dermatitis were similar, at a completion average of 28 minutes. The centers with extended initial assessment duration had multidisciplinary care team members evaluate the patient and performed full-body skin assessments. Further, the extensive use of electronic health records (EHR) was implemented in centers with more advanced methodologies to monitor patient progress and track severity.

Takeaways

“Many implementations focused on using established criteria and instruments, adhering to guidelines, increasing communication with patients and HCP, and educating PCPs, patients, and caregivers about AD,” investigators wrote.

The study, “Good Practice Intervention for Clinical Assessment and Diagnosis of Atopic Dermatitis: Findings from the Atopic Dermatitis Quality of Care Initiative,” was published in Dermatologic Therapy.