Findings

Supporting healthcare professional (HCP) education

Supporting healthcare professional (HCP) education

What is the challenge?
  • AD can be a complex condition for HCPs to manage e.g. due to its fluctuating nature and associated conditions(a)
  • High volumes of dermatology patients are often managed in primary care, by professionals who have relatively low levels of dermatology education in their training programmes(b)
  • Healthcare professionals also play a vital role in educating patients. It is therefore important they understand how best to do this(c)
Delivering, facilitating or enabling education for healthcare professionals (HCPs) involved in the care of AD patients directly or indirectly regarding recommended management approach
What is the goal/s of the intervention?
  • Improve HCPs’ understanding of AD and recommended management approach
  • Ensure HCPs are aware of when to refer AD patients to specialists
  • Empower HCPs to manage AD patients within their centres (where appropriate for the patient)
Who is often involved in the intervention?

Note: the same type of HCPs may be involved in both the delivery and receiving of education

  • Dermatologist
  • Comorbidity specialist (e.g. allergist, pulmonologist, ophthalmologist)
  • Paediatrician
  • Primary Care Practitioner (PCP)
  • Trainee dermatologist/trainee comorbidity specialist/medical student
  • Nurse/medical assistant/physician assistant
  • Clinical Pharmacist
  • Psychosocial professional (e.g. psychologist, psychiatrist, social worker)
  • Patient Group/Medical society (provision only)
What are the potential outcomes?

Patients

  • Improved management of AD by HCPs resulting in better disease outcomes (e.g. reduced likelihood of hospitalisation) and potentially decreased travel burden (if care can be provided closer to patient’s home through a PCP who has received AD-specific education)
  • Quicker referral to secondary and specialist care (where required)
  • Access provided to more detailed and informed AD education that can be provided by more HCPs

HCPs

  • Sharing of specialist knowledge between HCPs
  • Improved management of patients and their symptoms, reducing the demand on clinic resources
  • Reduction in unnecessary referrals to HCPs in secondary care if PCPs can confidently manage AD patient, therefore alleviating capacity (e.g. consultation availability and physical resources)

Healthcare system

  • Potential cost-efficiencies if treatment can remain in primary/secondary care without having to be referred to specialist(d)
(a)

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;

(b)

Kownacki S. Skin diseases in primary care: what should GPs be doing? Br J Gen Pract. 2014;64(625):380–381. doi:10.3399/bjgp14X680773;

(c)

Choumane N, et al. A multicenter, prospective study evaluating the impact of the clinical pharmacist-physician counsellingon warfarin therapy management in Lebanon. 2018;18(1):80. doi: 10.1186/s12913-018-2874-7;

(d)

TELEDERM®. The MOLE clinic [Website] http://www.telederm.uk.com/ Accessed 5 Nov 2019

What is offered as part of the intervention?

Topics often covered in HCP education include:

  • Information on AD as a disease
    • Causes and burden of AD
    • Allergic (atopy) and non-allergic comorbidities
  • Diagnosis and categorisation of AD and comorbidities
    • Clinical symptoms
    • Indication of allergy tests (e.g. IgE, patch, skin prick)
    • Scoring indices
  • Referral of patients (i.e. when, who and how to refer)
    • For AD and comorbidities
  • Medical management of AD
    • Treatment guidelines/options (available and upcoming)
    • Treatment application and usage (including amount, frequency, duration and location of body)
    • Management of flares, infections and triggers
    • Patient case studies (e.g. complex cases)
  • Non-medical management of AD
    • Recommended care regimen (e.g. hygiene advice, nutrition, wet wrapping)
    • Advice for living with the disease (e.g. psychological coping mechanisms, management of itch)
    • Additional sources of reliable information or support patients can access at the centre or elsewhere (e.g. Patient Advocacy Groups [PAGs])
  • Education approach for AD patients, parents and care givers (e.g. how to educate, what to educate on)
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 and whether these would be educational activities delivered or performed by AD specialists for non-AD specialists (e.g. primary care practitioners, general dermatologists, dermatology nurses, AD specialists or both (non-AD specialist and specialist). The level of resource may vary across centres/settings (e.g. depending on existing resources)

EASY
Non-AD specialist
  • Providing educational materials about AD to non-AD specialists
  • Providing formal or informal specialist contact within own centre to ask management questions to (e.g. via telephone or email)
  • Incorporating management advice and recommendation into referral letters/discussions and/or when providing test results for internal and external HCPs
AD specialist
Both
  • Enabling shadowing of AD or comorbidity consultations/clinics (for internal HCPs)
  • Inviting different internal HCPs to attend or speak at team meetings to provide specialist input (e.g. dermatologist, comorbidity specialist)
MEDIUM
Non-AD specialist
  • Delivering the following in collaboration with other centres/experts, Patient Groups, medical societies/groups:
    • Bespoke remote-access educational meeting or workshops
    • Face-to-face educational sessions or lectures as part of existing events (e.g. conferences)
AD specialist
  • Collaborating in cross-specialty research within centre (improving knowledge of each others’ speciality)
  • Conducting joint HCP consultations for patients (e.g. dermatologist and psychologist)
  • Holding multidisciplinary team meetings across specialists within centre/from other centres
Both
  • Attending continuing professional development courses (e.g. conferences)
  • Enabling shadowing of AD or comorbidity consultations/clinics (for external HCPs)
ADVANCED
Non-AD specialist
  • Employing HCPs that split their time across the community and specialist hospitals, or hiring AD specialists to help upskill other team members
  • Delivering the following in collaboration with other centres/experts, Patient Groups, medical societies/groups:
    • Bespoke face-to-face educational meeting or workshops
    • Train-the-trainer sessions as part of a ‘train-the-trainer model’ (i.e. non-specialists would then go educate others about AD)
    • E-learning modules
  • Creating computer software pop-ups/‘smartsets’/forms to guide patient information collected and inform treatment decisions (i.e. nudging)
AD specialist
  • Creating cross-specialty departments or units (e.g. joint dermatology and allergology department, allergy centre) within centre to facilitate AD education
  • Offering cross-specialty training (e.g. fellowship programme)
  • Establishing a cross-centre network of AD specialists to regularly discuss care, case studies etc.
  • Developing multidisciplinary teams for complex AD patient management within centre
Both
  • Creating a teleconsultation service to discuss patient cases (specialist or non-specialist)
  • Specialists developing AD management guidelines/ recommendations and AD outcome measures to guide care delivery
Relevant centre case studies

Delivering HCP education

Face-to-face educational sessions or lectures

Allergy Centre, Dokkyo Medical University Hospital, Japan

Dermatology Academy, UNIMORE (Modena), Italy

Educating primary care providers, Royal Devon & Exeter Hospital, UK

Educating the wider medical community, UMC Groningen, Netherlands

HCP education (including nurse platform), UMC Utrecht, Netherlands

Healthcare professional education seminars, Hiroshima University Hospital, Japan

Healthcare professional education, UniCATT (Rome), Italy

Provision of educational sessions, Dermatology Treatment and Research Center (Texas), USA

Provision of HCP education, UKSH (Kiel), Germany

Provision of HCP education, Women’s College Hospital (Toronto), Canada

Provision of healthcare assistant education, CMSS (Selters), Germany

Provision of therapeutic education, CH Lyon-Sud, France

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

Focus on healthcare professional education, Dermatology Treatment and Research Center (Texas), USA

Remote-access educational meeting or workshops

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

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

Train-the-trainer sessions

Healthcare professional education: ‘Train-the-trainer’, University of São Paulo Hospital, Brazil

Provision of therapeutic education, CH Lyon-Sud, France

Education for different professionals and the general public, Hiroshima University Hospital, Japan

Healthcare professional education seminars, Hiroshima University Hospital, Japan

Conducting joint HCP consultations for patients

Allergy centre comorbidity clinic, Aarhus Universitetshospital, Denmark

Joint paediatric dermatology-allergy clinic, Royal Devon & Exeter Hospital, UK

Joint psychiatry-dermatology clinics, CHRU Brest, France

Multidisciplinary Atopic Dermatitis Program (MADP), Rady Children's Hospital (California), USA

Onsite dermatology psychologist, Hospital Sant Pau (Barcelona), Spain

Psycho-derm clinic, Royal Devon & Exeter Hospital, UK

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

Development of AD management guidelines and outcome measures

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

Development of Japanese AD guidelines, Hiroshima University Hospital, Japan

Development of locally tailored recommendations, Rabin Medical Centre (Petah Tikva), Israel

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

Creating a teleconsultation service to discuss patient cases

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

MedPhone application, CH Lyon-Sud, France

Teledermatology service, Royal Devon & Exeter Hospital, UK

Employing HCPs that split their time across the community and specialist hospitals

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

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

Creating computer software pop-ups/‘smartsets’/forms to guide patient information collected and inform treatment decisions

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

Self-designed patient data collection tool, UKSH (Kiel), Germany

Incorporating management advice and recommendation into referral letters/discussions and/or when providing test results for internal and external HCPs

Frequent advice for primary care professionals, Harrogate District Hospital, UK

Primary Care professional-Dermatology-Laboratory network, UNIMORE (Modena), Italy

Inviting different internal HCPs to attend or speak at team meetings to provide specialist input

AD occupational training and advice, UNIMORE (Modena), Italy

Role of occupational health physician, UMC Groningen, Netherlands

Creating cross-specialty departments or units

Established dermo-allergy unit, Hospital La Paz (Madrid), Spain

Offering cross-specialty training

Multidisciplinary dermatology and allergy & immunology collaborative fellowship program, Rady Children's Hospital (California), USA

Establishing a cross-centre network of AD specialists to regularly discuss care

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