Identifying and improving quality of care in AD

A new report identifies several universal gaps in diagnosis and treatment of atopic dermatitis (AD) and suggests real-world interventions for improvement.

“I’ve never seen this done anywhere else in dermatology,” says Eric L. Simpson, MD, professor of dermatology at Oregon Health & Science University (OHSU) and a member of the report’s steering committee. “It was a very ambitious goal — how to improve quality of care for patients with atopic dermatitis on a global scale.” 

Commissioned by Sanofi Genzyme & Regeneron and assembled by KPMG, “Improving Quality of Care in Atopic Dermatitis” identifies gaps in areas ranging from patient awareness to physicians’ monitoring of long-term treatment. Based on literature reviews, input from AD experts and visits to 32 care centers worldwide, the 734-slide report offers targeted interventions supported by hundreds of clickable case studies.

“They sent a team out for days to each center to interview everyone involved with care — not just the physicians, but also the nurses and support staff — to find out their shared challenges, and the approaches to care that make them leaders.”

For ease of use, the report highlights 10 good-practice interventions along the patient-care pathway and places high priority on these five:

• Clinical diagnosis and assessment
• Patient education and communication
• Coordinated and structured multidisciplinary teams
• Monitoring and evaluating care quality
• Collaboration and exchange with patient groups

Regarding diagnosis and assessment, says Dr. Simpson, dermatologists and primary care physicians are skilled at diagnosing AD, but assessing its severity poses challenges.

Fortunately, he says, anyone who sees patients with AD can benefit from one or more of the highlighted interventions. “We’ve ranked the interventions they can bring into their practice as easy, medium and difficult. So you can pick and choose which makes sense for your current situation.”

An easy intervention could involve implementing a patient-reported outcome (PRO) instrument. “Using a feasible patient-reported outcome for a busy clinical practice, you can better understand disease severity and have better therapeutic discussions with your patients. That will provide overall better quality of care for your patients.” 

Elsewhere in the report, Dr. Simpson says, he was impressed by how much time providers at Centre Hospitalier Universitaire Lyon in Lyon, France, spend educating patients, both one-on-one and through an in-house curriculum. “It’s not just a one-time thing. And I’ve learned from other universities and approaches that even use patients to educate other patients, and to support other patients through navigating the medical system and social issues.” The report opened his eyes to the need for a broader team to support multiple aspects of patient health, he says.

Perhaps the report’s greatest impact will be to crush complacency. “We thought we had a great center. We see severe cases, and we have our established referral network,” says Dr. Simpson. But the report showed him that OHSU was nowhere near the mountaintop of multidisciplinary teamwork.

“When you look globally, people have such a variety of approaches to the challenges — how do they educate and support patients? You can find the gold standard out there amongst these clinics and emulate them if it seems like it would work for your health system. I’m in the process of changing my practice based on this document.”

Before getting involved with the report, Dr. Simpson says, his approach (which included having his own allergist and contact allergy specialist) involved “easy” and “medium” interventions. “The more challenging intervention that can potentially promote even better care is having a multidisciplinary clinic, where patients see more than one specialist that’s important to their care.” 

Accordingly, his department is incorporating adult and pediatric allergists, plus a contact dermatitis specialist to provide patch testing for patients who need it. “It’s going to provide convenience for the participant and improve communication among all of us in one sitting.”

Regarding utilization of support groups, the report spotlights OHSU’s close ties to the National Eczema Association (NEA). This relationship has given patients a trusted source of education and updates on emerging therapies, and a way to connect with other patients, says Dr. Simpson. “And the NEA has funded important research projects in our department. In turn, I would recommend that everyone not only use them, but also volunteer. It’s a win-win for providers and patients.”

Reference:

KPMG, Sanofi Genzyme & Regeneron. Improving quality of care in atopic dermatitis. https://atopicdermatitiscare.kpmg.co.uk/. Published October 29, 2020. Accessed November 3, 2020.

Disclosure:

Dr. Simpson has been a consultant and investigator for Sanofi and Regeneron.