Patients with atopic dermatitis who received care through a team-based connected health model experienced improvements in disease severity and symptoms comparable to those achieved with conventional in-person care over 12 months.
Researchers conducted a pragmatic randomized clinical equivalence trial involving 300 pediatric and adult patients with physician-diagnosed atopic dermatitis (AD) who were enrolled from 8 outpatient dermatology clinics in California between August 2019 and May 2024. Participants aged 1 year or older were randomly assigned to receive either asynchronous online care through a team-based connected health platform or conventional in-person care. Dermatologists in the online arm remotely reviewed patients' clinical histories and photographs, provided treatment recommendations through a secure platform, and coordinated care with primary care practitioners as needed.
The primary outcome was change in the Eczema Area and Severity Index (EASI) over 12 months. Secondary outcomes included changes in the Patient-Oriented Eczema Measure (POEM) and the validated Investigator Global Assessment (vIGA), assessed quarterly throughout follow-up.
Among the 300 randomized patients, 149 received team-based connected health care and 151 received conventional in-person care. The mean age was 35 years, and 70% were female. More than 95% of participants completed each follow-up assessment.
The connected health model met the study's prespecified criteria for equivalence on the primary outcome, with improvements in EASI comparable to those observed with in-person care. Improvements in patient-reported symptoms measured by POEM and physician-assessed disease severity measured by vIGA also met the predefined criteria for equivalence, indicating similar clinical outcomes across all major efficacy measures.
Safety outcomes were comparable between the groups. Serious adverse events were uncommon and unrelated to the study interventions. No deaths occurred during follow-up.
The investigators also reported substantially lower use of in-person specialty care among patients assigned to the connected health model. Only six patients in the online group required an in-person dermatologist visit during the 12-month study, compared with an average of 2.4 in-person visits per participant in the conventional care group.
The researchers noted that the findings build on previous teledermatology studies by demonstrating equivalent long-term outcomes using validated clinical measures in both pediatric and adult patients while maintaining high participant retention.
The study had several limitations. Baseline disease severity was relatively low, which may limit generalizability to patients with more severe AD. Participation also required internet access and the ability to submit digital photographs, potentially limiting applicability in populations with lower digital access or digital literacy. In addition, part of the study was conducted during the COVID-19 pandemic, when telemedicine use may have been greater than under usual practice conditions.
Overall, the findings suggest that a team-based connected health model may provide an effective alternative to conventional in-person care for many patients with AD while expanding access to dermatology services.
"This randomized clinical trial demonstrated that an online, team-based connected health model can deliver equivalent improvements in AD signs and symptoms compared with in-person care," wrote lead study author April W. Armstrong, MD, of the University of California, Los Angeles, and colleagues.
Disclosures: The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Armstrong and several coauthors reported financial relationships outside the submitted work. No other disclosures were reported.
Source: JAMA Dermatology
