Improving Atopic Dermatitis Care

Improving Atopic Dermatitis Care Posted By:
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Facilitating Improvements in Transitions of Care in AD Management
Atopic dermatitis (AD) is a chronic, inflammatory condition often presenting in childhood. While AD can be mild and easily managed with lifestyle changes and topical therapies, many will experience moderate to severe symptoms requiring systemic and/or lifelong therapy. As such, healthcare professionals (HCPs) need to intentionally plan for transitions of care for our patients with AD. This includes empowering young patients while they are adolescents.

The philosophy of care in a pediatric practice can be much more hands-on and nurturing; guiding patients and caregivers without significant expectations for the patients to take responsibility for their own care. There is certainly a place for this approach, but along the way, strategies for transitions of care should also make room for more patient autonomy and involvement of adolescents in shared decision-making.

In addition, pediatric and adult care HCPs should collaborate and communicate regularly. Streamlined and productive communication between these teams is essential to ensuring patients receive optimal care and have a network to ensure their needs and priorities are addressed. Maintaining adequate care overlap and effective communication will ensure patients have an avenue for addressing any concerns they may have, especially if there are conflicts in therapeutic approaches between the teams.

It is imperative that discussions about the transition of care process start early and when appropriate for the patient. The European Academy of Allergy and Clinical Immunology has developed guidance recommending initial discussions about transitions of care when patients are between 11 and 13 years of age. Some dermatology programs won’t see patients older than age 16. HCPs need to make pediatric patients aware of that and structure an age-appropriate process of education and empowerment early enough to allow for growth over time. After transitioning into the adult care practice, support from the pediatric care team can last for a while, until 25 years of age or so, to really make sure that the patient is embedded into the new system of care.

Recognizing and Addressing Healthcare Disparities in AD
Many patients with AD also experience barriers to care due to ongoing healthcare disparities. Addressing healthcare disparities is another crucial topic in improving AD outcomes. It is so important to remember HCPs are treating patients and not just treating a disease in a textbook. HCPs can design the best therapy plan in the world, and if there are barriers to getting or using it, the patient is not going to get better.

Oftentimes, learning to recognize and make plans for addressing these disparities starts with a personal reflection of one’s own implicit or explicit biases in addition to the way such biases have shaped the systems in which they work. Although these are critical to undertake, they are among many important dimensions of social determinants of health to consider. A few specific disparities key for AD care are discussed here.

First, differences in clinical presentation and measurable outcomes in AD across racial and ethnic groups must be considered. For example, compared with White patients, Black patients are more likely to have AD with papular, follicular eruptions, less obvious erythema, and more significant components of postinflammatory hyperpigmentation. Asian patients with AD often have more clearly demarcated lesions that can appear psoriasiform, with more prominent scaling compared to White patients. A disregard of these considerations can result in delayed or misdiagnosis and inadequate or improper treatment. In addition, racial and ethnic minorities are more likely to have treatment resistant and more moderate to severe disease vs milder disease in White patients.

Luckily, there are some supports and strategies available for HCPs to consider and implement as appropriate. Some of these tools are reserved for addressing social determinants of health on a larger, systematic scale. This would include addressing gaps in clinician education, raising awareness, improving competency through continuing professional development for HCPs, and working with state and national partners to improve care throughout health systems. However, it is just as important to work to decrease disparities on an individual level. This can be accomplished by working to strengthen the patient–HCP relationship, mindfully increasing diversity and minority representation in practices, employing strategies to diversify representation in clinical trials, and so on.

Then from a practical perspective, HCPs should make sure each patient has appropriate access to care; sometimes that can mean expanding office hours to include nights and weekends, increasing appointment flexibility, offering high-quality telephone and virtual clinical services, and maintaining avenues for after-hour questions; these can all have a big impact on patient quality of life. For those with cost and coverage barriers, providing information (eg, verbal education or printed handouts on resources to decrease out-of-pocket expenses) or support (eg, staff who can help navigate prior authorization hurdles) for acquiring affordable, but evidence-based therapies can be incredibly helpful. HCPs should ensure they are also respecting patients as the expert on their own life, culture, body, and preferences. Viewing patients as key members of the shared decision-making team is crucial for building a rapport and meeting their individualized needs. For example, if a patient is concerned about a cultural bias or misunderstanding with their care team, strategies to navigate individualizing their care and including them in plan development can help to develop a plan that meets the goals of the team and the patient.


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Filed under: Dermatology , NPs & PAs , Allergy/Immunology

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