CE / CME
Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit
Nurse Practitioners: 1.00 Nursing contact hours, includes 1.00 hour of pharmacotherapy credit
Released: January 15, 2025
Expiration: January 14, 2026
Patient Perspective: Best Paths to Improve Outcomes
Patient-Directed Strategies to Address Disparities
One of the most significant challenges we face is determining how to address disparities in care. It is well-documented that patients from minority populations are not experiencing the same level of improvement from our services as we would hope to provide.
There are multiple strategies we can implement to address these healthcare disparities, though each presents its own challenges. One potential strategy is to expand office hours to include evenings and weekends. Although this may be met with some hesitation among HCPs, it could be made more feasible by offering incentives to those willing to work these less traditional shifts. Such adjustments could significantly improve accessibility for patients who otherwise struggle to attend appointments during standard hours.7,40
Another strategy is to increase appointment flexibility and offer urgent visits. This would be particularly beneficial for patients who are experiencing a severe eczema flare-up and require immediate attention rather than waiting for an appointment scheduled months out. Without timely access, we fail to meet patients’ needs effectively.7,40
Providing a 24-hour telephone service for patients is important. Many practices already offer on-call services, and this should be maintained as a standard of care. In addition, telehealth visits represent an excellent opportunity to decrease barriers related to travel, productivity loss, and absenteeism. Although I initially disliked telemedicine during the pandemic due to the sudden transition and associated challenges, I have come to appreciate its value. Patients find it convenient, and I have noticed that video visits tend to be more time-efficient compared to in-person visits, allowing me to see more patients within the same timeframe. For practices not yet utilizing telemedicine, this is an option worth considering.7,40
Educational materials must be tailored to diverse patient needs, with adequate time allocated for patient education at each visit. I also like to include after-visit summary handouts in my patients’ charts, particularly for those managing eczema. The Society for Pediatric Dermatology has great patient education handouts in many languages, which I highly recommend, and are freely accessible online and can be printed for patient use.7,40
Another important aspect is assisting with medication access and adherence. This includes verifying insurance coverage prior to prescription, exploring mail-order delivery options for patients with limited transportation, and monitoring adherence. Frequent follow-ups, even brief telemedicine check-ins, can help ensure patient adherence. Studies indicate that the more frequently patients are seen, the more consistently they use their medications. During these check-ins, we can address practical concerns such as medication supply, side effects (eg, burning sensations), and proper application technique. This increased frequency of patient contact can significantly improve therapeutic outcomes.7,40
Strategies to Address Systemic Contributors to Healthcare Disparities
When addressing systemic contributors to health disparities, we must consider strategies that target the bigger picture.
One such strategy is increasing education and awareness among HCPs. That is what we are doing today. I appreciate your participation and commitment to learning about this critical topic. Acknowledging the existence of a problem is the first step toward finding a solution.7,41
Another approach is strengthening patient and provider relationships. Building trust through shared decision-making and demonstrating genuine care for patients is essential. Many of the strategies discussed earlier contribute to fostering these strong provider–patient relationships.7,41
Increasing diversity and minority representation among HCPs and staff is important, though it requires time. By encouraging children to envision careers in dermatology, as nurse practitioners, physician associates, or dermatologists, we can inspire future generations. Over time, this effort can lead to more diverse staffing in dermatology offices and healthcare settings.42
Facilitating diversity in referrals and clinical trial participation is another area of importance. This is something I recognize as an area for personal improvement in my own practice. HCPs should stay informed about clinical trials available that might be accessible to certain patients, both locally and regionally. Encouraging diverse participation in these trials enhances our overall understanding of diseases and leads to more representative research outcomes.30
Shared Decision-making in AD
Shared decision making is a cornerstone of patient care that I have emphasized repeatedly. Its growing importance is evident in our evolving assessment methods for patients with AD, particularly with tools like the ADCT, which incorporates the patient’s perception of their disease burden.28,29
Our approach has evolved significantly from historical methods that relied solely on visual assessment. We must actively engage with and listen to patients and their caregivers to understand the comprehensive impact of the disease on their daily lives. For example, an infant with AD presents with seemingly minimal disease involvement, yet the condition severely disrupts sleep pattern for the entire family. Recognizing and addressing these broader impacts is central to shared decision-making.43,44
We must accommodate patients’ varying economic and appointment scheduling need requirements. Asking patients whether telemedicine appointments are appropriate and accessible, or if in-person visits are preferred due to limited internet access can significantly improve care delivery. Facilitating closer follow-up when needed, whether initiated by the patient or HCP, is another way to ensure optimal outcomes.43,44
Considering the patient's goals, preferences, and cultural skincare practices is equally important. For example, if a patient has extensive scalp involvement but follows a complicated hair routine, recommending a treatment that disrupts this routine may not be practical. Engaging in conversations about how treatments can fit into their daily lives ensures that prescribed regimens are both manageable and effective. If topical treatments pose a significant burden, it may be worth exploring systemic options based on their symptoms and experiences.43,44
Supporting medication access and resource utilization remains critical. This includes ensuring medication affordability and providing comprehensive support throughout the treatment decision-making process.
Resources to Facilitate Shared Decision-making
To enhance shared decision-making, we must utilize a range of office-based resources to create a welcoming and comfortable environment. Most of us already work with multidisciplinary approach, a great mix of medical assistants, nurses, and pharmacists—it's that team approach that makes a difference.43,44
We cannot forget about emotional and psychosocial support. When our patients are really struggling, sometimes they need more than just dermatology care and referral to social work services or other specialties may be beneficial. Given the numerous comorbidities associated with AD, maintaining a comprehensive referral network comes in handy. Just like we check in with our patients with psoriasis about other symptoms, we should be asking our patients with AD about their overall well-being. This includes screening for mood disorders, attention deficit/ hyperactivity disorders in patients presenting with concentration difficulties or restlessness, and early evaluation for metabolic syndrome in patients with elevated body mass index.43,44
Internal training for clinic staff and HCPs so that all team members understand the comorbidities and unique needs of patients with AD enables us to provide better, more accommodating care. We need to be on the lookout and ready to help.45
Educational tools play a significant role. A particularly valuable resource is EczemaWise, an interactive website developed by the National Eczema Association. This platform allows patients to log their symptoms and treatments while tracking their progress. Patients find it highly engaging and beneficial.46
In addition, numerous resources are available that offer patient-friendly medication education in multiple languages. We often discuss treatment plans during exams, but patients don’t remember everything we say. Providing supplemental materials—whether in the form of handouts, accessible websites, or user-friendly apps—ensures that patients have ongoing access to educational resources. It helps them feel more in control of their care, and makes a huge difference in how well they stick to their treatment plan.45,46
Employing Motivational Interviewing
Let me share some effective ways I’ve found to really connect with and motivate my patients during their visits. First, it’s all about building that connection—getting the patients perspective and forming a relationship. I’ve found that simply asking permission goes a long way: “Is it okay if I check these areas?” or “Would you mind if we talk about how you’re sleeping?” These small courtesies really help build trust.47
I always try to let patients guide the conversation about what matters most to them. "What bothers you most about your AD?" or "What are your main concerns?” allows patients to feel heard and tailor treatment discussions. When discussing treatment options, I present evidence of the risks and benefits of recommended medications in patient-friendly language and discuss the pros and cons. For example, if transitioning from topical to systemic medication, explain why it might be beneficial and engage the patient in reflecting on how such a change could impact their life.47
Something I find really helpful is asking patients to imagine 2 scenarios: "What would your life look like if we stick with our current approach? And what might it look like if we try this new treatment?" This really helps them think through their options.
Active listening is another cornerstone of effective communication. I'm a big believer in giving patients space to express themselves. Silence, though sometimes uncomfortable, can encourage patients to share more. You would be amazed at what patients will share if you just wait those extra few seconds.47
Instead of asking questions that get simple yes or no answers, I try to ask open-ended questions, such as "What are your thoughts on this treatment?" or "Can you tell me more about your experience?"
When it comes to making plans, I ask patients to consider how a new medication or approach might affect their daily life. Questions like, “What do you think you will need from me to make this work?” or “How can I support you in this process?” encourages a shared strategy that aligns with the patients’ goals and circumstances.
Crafting an Individualized Plan
Crafting personalized treatment plans helps patients navigate their own care. This is an example of an action plan, a tool many of you may already be familiar with. Numerous versions exist online, but this particular example is especially helpful when managing a complex routine involving multiple topical medications, such as specific soaps or treatments used at different times. An action plan serves as a day-to-day guide for patients and their families, providing clarity on managing their condition.
Let me break down how I structure these plans. Think of it like a traffic light system.
This action plan is developed collaboratively with the patient during office visits, empowering them to take it home as a practical, easy-to-follow game plan. It’s like a roadmap for managing their condition, tailored specific to each patient’s needs and circumstances.
Faculty Insights and Key Takeaways
To recap what we covered in this module, the key insights from today’s presentation include:
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