Findings

Sharing care of patients

Sharing care of patients

What is the challenge?
  • Due to resource constraints, physicians often have limited time they are able to spend in consultations with patients(a)
  • Other healthcare professionals (HCPs), such as nurses, can play a key role in the management of AD patients and can be more cost effective in delivering similar patient outcomes and higher patient satisfaction(a)
Empowering and enabling other team members (e.g. nurses, physician assistants, pharmacists) to support physicians with AD patient education and management, for more effective and efficient care delivery
What is the goal/s of the intervention?
  • Enable quicker/more frequent access to the care team
  • Provide patients with an additional HCP to give support and answer questions regarding management (that they may feel more comfortable engaging with e.g. asking questions)
  • Expand the role of other team members to reduce the burden on the physicians
Who is often involved in the intervention?

Note: in both primary care and secondary/tertiary care

  • Nurse
  • Medical assistant
  • Physician assistant
  • Pharmacist
What are the potential outcomes?

Patients

  • Access to additional 1:1 time with a HCP for personalised discussion and support
  • Opportunity to engage with another HCP who patients may feel more comfortable discussing/raising concerns and questions to (versus a physician)
  • Access to cross-specialty knowledge (e.g. if HCP works across departments)

HCPs

  • Other team members feel empowered and highly valued by the patients
  • Sharing of physician workload with the other team members (which is both time and cost-efficient)
  • Upskilling of other team members through patient care experience (in addition to any formal training to perform role)

Healthcare system

  • More cost-efficient delivery of patient care with similar or improved patient outcomes(b)
(a)

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;

(b)

Schuttelaar ML, et al. Costs and cost-effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs. Br J Dermatol. 2011;165(3):600-11

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
  • Supporting coordination of patient consultations (especially for complex patients)
  • Locating patient’s electronic medical record or referral notes ahead of first physician consultation
  • Collecting patient information and family history before physician consultation (and presenting information to physician)
  • Providing brief education following physician consultations (e.g. disease education, demonstration of treatment application, reviewing treatment plan) (~15 mins)
  • Performing AD scoring indices or patient reported outcomes (PROs) before/after or during consultations
  • Triaging patient questions received from patients (via telephone, email or online portal) to relevant HCP
  • Sharing information about additional support options (e.g. community HCPs, Patient Groups) within or outside consultations
  • Attending team meetings (i.e. being integrated into the team for discussion of patients etc.)
MEDIUM
  • Participating in cross-centre quality evaluation, involving a mail questionnaire or online survey assessing patient experiences
  • Designing a bespoke online database enabling the consistent collection and storage of patient data (e.g. EASI/SCORAD scores) in a format that can be easily analysed
  • Bringing together groups of HCPs to review patient care case studies to assess care approach
  • Designating dedicated human resource to monitor and evaluate data collection
  • Designing a dynamic process to allow for ongoing quality improvement/assessment/evaluation
ADVANCED
  • Developing a mobile phone application for education of patients
  • Designing and running Patient Group education/panels
  • Involvement in the setup of Patient Groups and member of advisory boards
  • Managing prior authorisation process of treatment for dermatology patients
  • Organising and delivering HCP education (for nurses and PCPs)
  • Prescribing treatment and/or creating treatment plans (where allowed)
Relevant centre case studies

1:1 or joint consultations with nurses/medical assistants

Dermatology Advanced Nurse Practitioner (ANP), UMC Utrecht, Netherlands

Enhanced role of the nurse, UMC Groningen, Netherlands

Enhanced role of the nurse, Women’s College Hospital (Toronto), Canada

Healthcare assistant led consultations, CMSS (Selters), Germany

Medical assistant-led consultations, Dermatology Treatment and Research Center (Texas), USA

Nurse led 1:1 education, CHRU Brest, France

Nurse led chronic disease clinic, Royal Devon & Exeter Hospital, UK

Nurse shared responsibilities, Aarhus Universitetshospital, Denmark

Nurse-led drug monitoring clinic, Harrogate District Hospital, UK

Nurse-led education consultations, Hiroshima University Hospital, Japan

Nurse-led patient education, Linkou Chang Gung Memorial Hospital (Taipei), Taiwan

Role of the Advanced Nurse Practitioner (ANP), Inselspital (Bern), Switzerland

Specialist study nurses, UKSH (Kiel), Germany

Telephone consultations, Harrogate District Hospital, UK

Use of medical assistants, DermAssociates (Washington), USA

Medical assistant-led support, Dermatology and Treatment Center (Texas), USA

Pharmacists

Multidisciplinary approach to patient education, The Jikei University Hospital, Japan

Supportive role of the pharmacist, Hospital Sant Pau (Barcelona), Spain

Physician assistants

Joint Allergy-Dermatology Physician Assistant, Rady Children's Hospital (California), USA

Prior authorisation nurse role, OHSU (Oregon), USA

Designing and running Patient Group education/panels

AD patient educational evenings, Inselspital (Bern), Switzerland

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

Provision of group therapeutic education, including “Walk of Skin” game, CHRU Brest, France

Organising and delivering HCP education

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

Role of the Advanced Nurse Practitioner (ANP), Inselspital (Bern), Switzerland

Role of biologic coordinator, Dermatology Treatment and Research Center (Texas), USA