Findings

Creation of collaborative internal & cross-centre networks

Creation of collaborative internal & cross-centre networks

What is the challenge?
  • Centres may not have the resources (nor ability to invest in) the personnel or facilities required for effective AD care delivery(a) or research
  • A lack of referral networks may further inhibit their ability for patients to access the necessary treatment(b)
Forming a collaborative network within and across centres (including both primary and secondary care) to optimise research, patient care and knowledge sharing
What is the goal/s of the intervention?
  • Share knowledge and experience across HCP networks to collectively improve care
  • Create efficient referral pathways and provide patients with access to specialists or facilities that may not be available at own centre
  • Enable pooling of resources across centres (e.g. to advocate for research, conduct larger scale research projects)
Who is often involved in the intervention?
  • Dermatologist
  • Nurse/medical assistant
  • Physician assistant
  • Trainee dermatologist
  • Comorbidity specialist (e.g. allergist)
  • Primary care practitioner (PCP)
  • Laboratory staff (e.g. researcher, scientist)
  • Clinical trial staff (e.g. study coordinator/recruiter, epidemiologist)
What are the potential outcomes?

Patients

  • Access to treatment and holistic care (e.g. for comorbidities) from across specialties
  • Reduced travel and time burden for patients, as they are able to receive specialist care close to home
  • Opportunity to participate in research projects/clinical trials

HCPs

  • Greater access to wider patient pool, including those who might not be able to travel to the main treating clinic
  • Ability to provide holistic care to patients who require comorbidity treatment
  • Sharing of knowledge between care settings and upskilling of community HCPs

Healthcare systems

  • Potential cost-efficiencies through sharing or pooling resources across centres (versus having to provide at each centre) and providing patient care within community settings (instead of hospitals)
(a)

Le Roux E, et al. GPs experiences of diagnosing and managing childhood eczema, BJGP 2019 [PDF] https://bjgp.org/content/bjgp/early/ 2018/01/16/bjgp18X694529.full.pdf Assessed 21 Mar 2019;

(b)

Allergy UK and Sanofi Genzyme. Seeing Red: Getting under the skin of adult severe eczema. 2017 [Website] https://www.allergyuk.orghttps://live-secureportal.azurewebsites.net/000/ 001/411/Seeing_Red_Report_FINAL_25.04.17_original.pdf? 1508228476 Accessed 5 Nov 2019; (c) KPMG interviews

What is offered as part of the intervention and how has it 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
  • Building relationships with local centres of comorbidity specialists for referrals
  • Hosting HCPs from different centres, such as attending team meetings to discuss complex patients cases, lecture etc.
  • Performing regular internal research meetings between centre clinical research laboratory and university dermatology research laboratory
MEDIUM
  • Providing specialist care in the community via smaller clinics/satellite clinics
  • Creating referral networks (between PCPs/general dermatologists and AD specialists)
  • Creating a cross-centre regional network of HCPs involved in the management of eczema who meet regularly (e.g. to discuss complex cases)
  • Hiring HCPs who have trained at other national or international centres (so have existing relationships)
  • Collaborating on local, national or international research projects and clinical trials (with HCPs in primary and secondary care)
  • Integrating a community dermatologist into specialist centre outpatient clinics (to increase exposure and treating confidence of severe AD patients and act as liaison with primary care)
  • Centres collaborating to support Patient Groups with activities including grant applications, patient education, patient referrals, research and the writing of AD protocols and guidelines
  • Providing face-to-face HCP training sessions (for general dermatologists, PCPs, nurses, medical students etc.)
  • Enabling teleconsultations between specialists and other specialists or Primary Care Practitioners (PCPs) via mobile phones/computers
  • Providing a HCP smartphone application portal for centre network to provide HCPs with immediate access to patient lists, patient medications, research results and referral information
  • Developing AD educational and health information technology resources (e.g. ‘smartset’) for paediatricians (and their patients) in primary care
ADVANCED
  • Supporting setup and/or running of Patient Groups
  • Setting up cross-specialist internal departments
  • Establishing smaller community clinics/satellite clinics external to the parent clinic
  • Connecting electronic medical records (full or partial) to share referred patient information
  • Facilitating cross-centre development of treatment principles/care algorithms, guidelines and recommendations, AD scoring indices, PRO or QoL measures etc.
  • Promoting national cross-centre setup and participation in AD registries and biobanks (for clinical research)
Relevant centre case studies

Collaboration on local, national or international research projects

Clinical trials participation, DermAssociates (Washington), USA

Integrated clinical and research laboratories, Aarhus Universitetshospital, Denmark

PCP-Dermatology-Laboratory network, UNIMORE (Modena), Italy

Specialist laboratory attesting and interpretation, UNIMORE (Modena), Italy

Working with the VMCE, UMC Utrecht, Netherlands/UMC Groningen, Netherlands

Pruritus National Reference Centre, CHRU Brest, France

National patient database, Linkou Chang Gung Memorial Hospital (Taipei), Taiwan

Development of Japanese guidelines for AD, Hiroshima University Hospital, Japan

Collaboration on the provision of patient and HCP education

Globally trained dermatologists and residents, Rabin Medical Centre (Petah Tikva), Israel

Healthcare professional education, UniCATT (Rome), Italy

Healthcare professional education seminars, Hiroshima University Hospital, Japan

Primary care dermatology education, Hospital La Paz (Madrid), Spain

Provision of HCP education, UKSH (Kiel), Germany

Building relationships with local centres of comorbidity specialists for referrals

Comorbidity specialist network, DermAssociates (Washington), USA

Established specialist network, Medical Dermatology Associates of Chicago, USA

Referral to co-morbidity specialists, M.L.F. Knuckles Dermatology (Kentucky), USA

Enabling teleconsultations between specialists and other specialists or Primary Care Practitioners

Emergency room specialist hospital communication app, Rady Children's Hospital (California), USA

Teledermatology service, Royal Devon & Exeter Hospital, UK

Use of telemedicine, Hospital Italiano de Buenos Aires, Argentina

Cross-centre development of treatment principles/care algorithms, guidelines and recommendations, AD scoring indices, PRO or QoLmeasures etc.

Consensus for the management and treatment of AD, Linkou Chang Gung Memorial Hospital (Taipei), Taiwan

Development of Japanese guidelines for AD, Hiroshima University Hospital, Japan

Harmonising Outcome Measures for Eczema (HOME) Initiative, Rabin Medical Centre (Petah Tikva), Israel / OHSU (Oregon), USA

A community-based assessment of skin care, allergies and eczema (CASCADE) trial, OHSU (Oregon), USA

Developing AD educational and health information technology resources (e.g. ‘smartset’) for paediatricians (and their patients) in primary care

Healthcare professional education, UniCATT (Rome), Italy

Improving Atopic Dermatitis Care by Paediatricians (IADCBP), Rady Children's Hospital (California), USA

Integrating a community dermatologist into specialist centre outpatient clinics

Integrated community dermatologist, Rabin Medical Centre (Petah Tikva), Israel

Integration of community dermatologists, Women’s College Hospital (Toronto), Canada

National cross-centre setup and participation in AD registries and biobanks

BioDay registry, UMC Utrecht, Netherlands/UMC Groningen, Netherlands

TREATgermany registry, UKSH (Kiel), Germany/CMSS (Selters), Germany

Providing specialist care in the community via smaller clinics/satellite clinics

Community outreach clinics for rural populations, Harrogate District Hospital, UK

Hospital Specialist Satellite Clinics, Rady Children's Hospital (California), USA

Supporting setup and/or running of Patient Groups

Working with the VMCE, UMC Utrecht, Netherlands/UMC Groningen, Netherlands

Working with the AADA, Hospital Sant Pau (Barcelona), Spain/Hospital La Paz (Madrid), Spain

Involvement with wider AD community, Mount Sinai & Ichan School of Medicine (New York), USA

Creating a cross-centre regional network of HCPs involved in the management of eczema who meet regularly

Centre Expert Eczema Network Auvergne Rhone Alpes, CH Lyon-Sud, France

Providing a HCP smartphone application portal for centre network

MedPhone application, CH Lyon-Sud, France

Hiring HCPs who have trained at other national or international centres

Globally trained dermatologists and residents, Rabin Medical Centre (Petah Tikva), Israel