Findings

Clinical diagnosis and assessment

Clinical diagnosis and assessment

What is the challenge?
  • There are a number of diseases that may mimic AD and atypical AD presentations that can lead to misdiagnosis(a)
  • HCPs may also struggle to determine AD severity, and each patient is individual in how they are effected by the disease (therefore patient needs and goals will differ)(b)
Ensuring patients receive a proper disease diagnosis, evaluation and disease assessment using established instruments, to inform their management approach in line with guidelines and recommendations
What is the goal/s of the intervention?

  • Reduce delays in access to appropriate care and symptom alleviation (e.g. itch)

  • Enable informed, therapeutic shared-decision making with patient, based on AD severity/impact assessment

  • Promote more efficient usage of limited resources through reducing the number of misdiagnoses and streamlining resources towards where they are needed most

  • Avoid unnecessary deterioration in the patient’s condition

  • Standardise care across the healthcare network in order to better promote adoption of leading industry practice and knowledge sharing

Who is often involved in the intervention?

  • Dermatologist

  • Nurse/medical assistant/physician assistant

  • Comorbidity specialist (e.g. allergist)

  • Paediatrician

  • Trainee dermatologist/medical student

  • Primary care practitioner (PCP)

What are the potential outcomes?

Patients

  • More timely and accurate diagnosis, resulting in quicker access to care and prevention of disease progression

  • Faster access to support to help manage and reduce symptoms, such as itch

  • Improved disease outcomes and reduced burden on QoL through quicker and more appropriate treatment initiation

HCPs

  • Reduction in time burden associated with dealing with mis-diagnoses and mis-referrals

  • Clearer disease management approach for HCPs to follow with a solid diagnosis and severity assessment (in line with guidelines and recommendations)

Healthcare system

  • Potential reduction in cost burden associated with incorrect referrals and initiation of unnecessary/incorrect treatments

(a)

Siegfried E, et al. Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. J Clin Med. 2015;4(5):884-917. doi:10.3390/jcm4050884;

(b)

Lee J, et al. A Comprehensive Review of the Treatment of Atopic Eczema. Allergy Asthma & Immunology Research. 2016;8(3):181-190. doi:10.4168/aair.2016.8.3.181

What is offered as part of the intervention and how has the intervention been implemented in different centres?

Note:    With input from the steering committee, we have categorised these activities by level of resource required to implement, however this may vary across centres/settings (e.g. depending on existing resources)

EASY
  • Performing a clinical history/examination to rule out differential diagnoses
  • Conducting clinical assessment of disease severity (e.g. extent and location of AD [presence on face and hands], intensity of inflammation [i.e. redness])
  • Identifying patients who are not responding to treatment (and ensuring this is due to treatment resistance versus e.g. incorrect treatment usage due to miseducation), and require step up treatment
  • Assessing AD impact on patients with informal questioning (e.g. mood, anxiety, sleep) or shorter patient reported outcome (PRO) measures (e.g. Itch NRS)
MEDIUM
  • Performing shorter validated diagnostic criteria assessments (e.g. AAD Diagnosis and Assessment consensus criteria)
  • Conducting or referring for additional differential diagnoses tests (e.g. patch tests, IgE, biopsies)
  • Conducting shorter validated disease assessment measures (e.g. VSA)
  • Assessing AD impact on patients with global PRO measures (e.g. GDA)
ADVANCED
  • Performing more comprehensive validated diagnostic criteria assessments (e.g. Hanifin and Rajka diagnostic criteria)
  • Conducting more comprehensive validated disease assessment measures (e.g. EASI, SCORAD)
  • Assessing AD impact on patients with longer PRO measures (e.g. POEM, DLQI)