Findings

Use of eHealth, mHealth & telehealth

Use of eHealth, mHealth & telehealth

What is the challenge?
  • Patients with AD (especially complex patients) may be required to travel regularly to HCP consultations, which can be time consuming, stressful and financially costly for them(a)
  • Depending on their location, there may also be limited access to HCPs with AD expertise(b)
  • Due to resource constraints physician/patients can have limited time in consultations to provide education, and/or patients may want to access information/support in between consultations(c)
Using electronic, mobile and tele-technology to improve the quality and efficiency of care delivered to AD patients
What is the goal/s of the intervention?
  • More efficient delivery of care through approaches which have the potential to save both time and money
  • Increased convenience for patients and HCPs in the delivery of care, thereby reducing patient burden and lessening demands on HCP’s time
  • Greater access to resources (e.g. patient and HCP information)
  • Provision of care to patients who otherwise may have been unable to access it
Who is often involved in the intervention?
  • Dermatologist
  • Nurse/medical assistant
  • Primary care practitioner (PCP)
  • Comorbidity specialist (e.g. allergist)
  • Trainee dermatologist
  • IT expert
  • Data protection and legal expert
What are the potential outcomes?

Patients

  • Ability to better manage their own disease through accessing guidance, consultations and condition updates online and at their convenience
  • Improved access to specialist care and reduced associated travel burden

HCPs

  • Efficient storage, transfer and analysis of data (e.g. for internal quality reviews, to create patient cohort for research)
  • Improved efficiency of consultations reducing demand on HCPs
  • Access to patients who may be unable to make the journey for in-person visits

Healthcare system

  • Potential reduction in number of patients accessing healthcare services in person and improved ability to analyse patient trends
(a)

Adamson AS. The Economics Burden of Atopic Dermatitis. Adv Exp Med Biol. 2017;1027:79-92. doi: 10.1007/978-3-319-64804-0_8;

(b)

Le Roux E, et al. GPs’ experiences of diagnosing and managing childhood in primary care. British Journal of General Practice 2018;68(667):73-80. doi:10.3399/bjgp18X694529;

(c)

Mehta S. Patent Satisfaction reporting and its implications for patient care. AMA Journal of Ethics. 2015 [Website] https://journalofethics.ama-assn.org /article/patient-satisfaction-reporting-and-its-implications- patient-care/2015-07 Accessed 5 Nov 2019

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
Patients
  • Creating a secure team email address that patients can send photos of their skin to
  • Establishing a dedicated phone line for patients to call for treatment advice
HCPs
  • Enabling HCPs to perform telephone consultations which can include a discussion of test results and guidance regarding treatment
MEDIUM
Patients
  • Enabling teleconsultations between specialists and patients via mobilephones/computers (e.g. via patient portal), of which can be supplemented with PROs
  • Creating an educational website containing online training resources for patients as a supplement to what is provided by HCPs during consultations
HCPs
  • Enabling teleconsultations between specialists and other specialists or Primary Care Practitioners (PCPs) via mobile phones/computers
  • Designing a local or centre database that creates consistency in data collected in patient consultations across team members, and can be used to check quality control processes (e.g. by checking the consistency of EASI/SCORAD measures), or track and monitor patient progress
ADVANCED
Patients
  • Developing a smart phone application for patients that provides resources such as treatment information, itch management guidance, treatment plans integrated into the user’s diary with set reminders, and educational tips and videos
HCPs
  • Connecting electronic medical records (full or partial) across centres to share referred patient information easily
  • Developing computer applications for local PCP network that can guide AD management (e.g. through treatment recommendation)
  • Developing a smart phone application to enable staff within the same network to securely share photos of AD, and gain access to patient lists, patient medications, research results and referral information
  • Using telemedicine infrastructure to capture patient information through creating e-cohorts
Relevant centre case studies

Enabling teleconsultations/information sharing

HCP – HCP


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

MedPhone application, CH Lyon-Sud, France

Use of technology, KFMC, Saudi Arabia

Teledermatology service, Royal Devon & Exeter Hospital, UK

Use of telehealth services, Aarhus Universitetshospital, Denmark

Use of telemedicine, Hospital Italiano de Buenos Aires, Argentina

Multi-disciplinary patient education, Cayre Clinical Center, Colombia

Collaboration on the provision of patient and HCP education

Patient – HCP


Communication via the patient portal, UMC Utrecht, Netherlands

Dedicated dermatology photographer, UMC Groningen, Netherlands

Digital consultation support, CMSS (Selters), Germany

Longer and frequent consultations, OHSU (Oregon), USA

Use of telemedicine, Hospital Italiano de Buenos Aires, Argentina

Patient-HCP consultation, Cayre Clinical Center, Colombia

Designing a local or centre database

Development of a local patient registry, UniCATT (Rome), Italy

Ongoing electronic health record (EHR) development, Hospital Italiano de Buenos Aires, Argentina

Self-designed patient database, CMSS (Selters), Germany

Structured patient assessment tool, UKSH (Kiel), Germany

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

Developing a smart phone application for patients

Innovative smartphone application: “Zalf”, UMC Utrecht, Netherlands

Physiotherapist relaxation and mobile app, Inselspital (Bern), Switzerland

Virtual Nurse mobile device application, McGill University Health Centre
(Montreal), Canada

Developing computer applications for local PCP network which can guide AD management

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

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

Facilitation of virtual consultations

Digital consultation support, CMSS (Selters), Germany

Telephone consultations, Harrogate District Hospital, UK

Enabling HCPs to perform telephone consultations

Digital consultation support, CMSS (Selters), Germany

Telephone consultations, Harrogate District Hospital, UK

Creating an educational website containing online training resources for patients

Innovative education website: “Leef! Met Eczeem”, UMC Utrecht, Netherlands