TOPLINE

Over 12 months, an online, team-based connected health (TCH) model achieved improvements in atopic dermatitis (AD) that were equal to in-person care.

METHODOLOGY

• Researchers conducted a pragmatic, randomized clinical equivalence trial of 300 children and adults (median age, 34.6 years; 70.3% female; 38.7% White, 37.3% Asian, 9.0% Black, and 28.7% Hispanic or Latino) with AD from eight outpatient dermatology clinics in California between August 2019 and May 2024.
• Participants were randomly assigned 1:1 to receive either online TCH care or conventional in-person care. At baseline, the mean Eczema Area and Severity Index (EASI), validated Investigator Global Assessment (vIGA), and Patient-Oriented Eczema Measure (POEM) scores were 4.87, 2.38, and 11.7, respectively.
• In the TCH group, dermatologists reviewed clinical histories and photographs submitted asynchronously by patients and provided assessments and treatment recommendations within 3 business days. Educational materials were available in English and Spanish.
• The primary outcome was change in EASI scores averaged over 12 months with a prespecified equivalence margin of ±6.5.
• Secondary outcomes included POEM and vIGA scores averaged over 12 months, with prespecified equivalence margins of ±3.4 and ±0.5, respectively.

TAKEAWAY

• Improvements in the severity of AD signs and symptoms with online TCH care were equivalent to those with conventional in-person care, with a difference in mean change in EASI of -0.01 (95% CI, -0.22 to 0.20), meeting the prespecified criteria.
• The differences in mean change in POEM (0.38; 95% CI, 0.03-0.73) and vIGA (0.06; 95% CI, 0.00-0.11) scores between online and in-person care groups were also within the equivalence margins.
• The rates of adverse events were comparable between the two groups; overall adverse events were reported in 24 participants (16.1%) in the online group and 22 participants (14.6%) in the in-person group; serious adverse events were rare and unrelated to interventions.
• Patients in the online group required a mean of only 0.07 dermatologist visits per participant during follow-up compared with a mean of 2.40 visits per participant in the conventional care group.

IN PRACTICE

“This randomized clinical trial demonstrated that an online, team-based connected health model can deliver equivalent improvements in AD signs and symptoms compared with in-person care,” the authors of the study concluded. The findings, they added, “highlight TCH’s potential to expand access and enhance continuity of care in chronic disease management.”

SOURCE

The study was led by April W. Armstrong, MD, MPH, Division of Dermatology, University of California, Los Angeles, and was published online on June 24 in JAMA Dermatology.

LIMITATIONS

The sample had a high proportion of women, baseline disease severity was relatively low, and part of the trial overlapped with the COVID pandemic. The TCH model may not be generalizable to populations with limited internet access or lower digital literacy.

DISCLOSURES

The study received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Armstrong disclosed receiving support from AbbVie, Alumis, BMS, Galderma, LEO Pharma, UCB, Johnson & Johnson, Eli Lilly and Company, Novartis, Sun Pharmaceutical Industries, Sanofi, Takeda Pharmaceutical Company, Regeneron Pharmaceuticals, and Pfizer through roles as a research investigator, scientific advisor, or speaker outside the submitted work. Full 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.