TOPLINE

A 12-month randomized equivalence trial found that an online team-based connected health (TCH) model achieved quality-of-life improvements equivalent to in-person care for atopic dermatitis (AD) and shortened the evaluation time at the initial visit.

METHODOLOGY

• Researchers conducted a 12-month pragmatic randomized controlled equivalence trial of 300 children aged 1 year or older and adults with physician-diagnosed AD from eight ambulatory clinics across Southern California.
• Participants were randomly assigned in a 1:1 ratio to receive either the online TCH model care or traditional in-person care. The mean participant age was 34.6 years; 70.3% were female, 38.7% were White, 37.3% were Asian, 9% were Black, and 28.7% were Hispanic. The proportion of pediatric patients younger than 18 years was 12.1% vs 14.6% in the online group vs the in-person group.
• The online TCH model enabled patients to submit histories and skin images online, while dermatologists and primary care physicians coordinated diagnosis, treatment, follow-up, and communication through a secure asynchronous platform.
• Primary outcomes included quality of life measured by the Dermatology Life Quality Index (DLQI) or Children’s DLQI and EQ-5D-5L or EQ-5D-Y at baseline and months 3, 6, 9, and 12, with equivalence margins of ± 4.0 for DLQI, ± 0.15 for utility index, and ± 10 for visual analog scale (VAS).
• Access-related outcomes included the patient-reported transportation mode at baseline and time needed for evaluation (including waiting time and time spent with the physician) assessed at baseline and all follow-up timepoints. Follow-up retention rates were more than 95%.

TAKEAWAY

• Online TCH care achieved quality-of-life improvements equivalent to in-person care, with a difference in mean DLQI change between the online and in-person groups of 0.12 (95% CI, -0.18 to 0.42), well within the prespecified equivalence margin.
• For EQ-5D-5L measures, the differences in mean utility index and VAS changes between groups were 0.00 (95% CI, -0.01 to 0.01) and -0.11 (95% CI, -0.70 to 0.48), respectively, both within prespecified equivalence margins.
• The online group required significantly less time for the baseline evaluation than the in-person group (51.6 vs 65.9 minutes; P = .03), although evaluation times were similar during follow-up visits.
• The mode of transportation did not differ significantly between the TCH and in-person arms.

IN PRACTICE

This trial found that the online TCH model “achieved quality-of-life improvements equivalent to in-person care and reduced the time needed for evaluation at baseline,” the authors of the study wrote. “As virtual care becomes increasingly integrated into health systems,” they added, “our findings support the patient-centered effectiveness of the online care model.”

SOURCE

The study was led by April W. Armstrong, MD, MPH, professor and chief, Division of Dermatology, Department of Medicine, University of California, Los Angeles, and was published online on June 26 in the Journal of Investigative Dermatology.

LIMITATIONS

Quality-of-life and access outcomes were self-reported, participants and providers could not be blinded, access measures were limited to transportation mode and evaluation time, the study did not compare individual TCH workflows or provider types, and a novelty effect could have influenced engagement with teledermatology.

DISCLOSURES

The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Armstrong and several other authors disclosed serving as a research investigator, scientific advisor, consultant, and speaker for multiple pharmaceutical companies, including AbbVie, Alumis Inc., Bristol Myers Squibb, Galderma, LEO Pharma, UCB, Johnson & Johnson, Eli Lilly and Company, and Novartis. One author also reported serving as an editor for journals and as a member of dermatology societies and councils. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.