SAN DIEGO -- The use of an online model to manage psoriasis was just as effective in improving clinical outcomes as in-person care, according to research presented here.
In fact, the researchers, led by April Armstrong, MD, MPH, of the Keck School of Medicine at the University of Southern California in Los Angeles, determined that in some cases the online model was superior to in-person care regarding assessments of psoriasis severity.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
The study was presented at the .
"We know that a lack of regular access to dermatology providers results in poor health outcomes," said Armstrong. "And when we think about the future we know that after 2020 there will be more people over the age of 65 than under the age of five, which means the population is continuously growing and there is a continuous need for dermatology and dermatology providers."
This potential problem is exacerbated, she noted, by workforce trends suggesting that in the case of dermatologists, demand is outstripping supply.
In addition, she pointed out, there are challenges associated with the traditional in-person care model, including a lack of collaboration and informed communication among patients, primary care physicians, and dermatologists.
Armstrong also noted that current generations are evolving into online consumers, "so they likely will be getting their healthcare online as well."
For the study, the researchers evaluated an online specialty-care delivery model to increase access to dermatologists and improve patient outcomes. "We decided to look at psoriasis because it's a chronic skin disease with a number of co-morbidities where we thought co-management by specialists and PCPs [primary care physicians], as well as communication between these two groups, is important."
For purposes of the study, an online visit involved either the PCP or psoriasis patient taking standardized photographs of their skin. The photos were uploaded to a connected site where dermatologists could access the images, evaluate them, and provide recommendations directly to the patient and PCP at the same time.
The study, which was funded by the Patient-Centered Outcomes Research Institute, enrolled 300 patients randomized 1:1 to online versus in-person care. Participants were 50% male, 63% white, and had a mean age of 49 and a baseline body surface area (BSA) of 8.5% (SD 12%).
Over 12 months, the adjusted repeated measures analysis showed that the difference in the average change in the Psoriasis Area and Severity Index (PASI), the primary outcome, between the online and in-person groups was -0.271 (95% CI -0.853 to 0.312). The average change in BSA between the two groups was -0.053% (95% CI -1.584% to 1.477%).
Between-group differences in PASI and BSA were within the pre-specified equivalence margins, which demonstrated equivalence between the two interventions, Armstrong reported.
In addition, the difference in the average change in Patient Global Assessment (PtGA) between the two groups was -0.111 (95% CI -0.317 to 0.096), which exceeded the equivalence margin, with the online group showing greater improvement in PtGA. "The online group actually thought they had lower disease severity over the course of the study compared to the in-person group," Armstrong said.
The online model was equivalent to the in-person model in terms of improving clinical outcomes, she said, adding that "we need to think about these innovative telehealth delivery models that emphasize collaboration, as well as quality."
Armstrong cautioned that while the study shows that an online model is equivalent to in-person care in terms of patient outcomes, for the model to be sustainable physicians would have to ensure they would be properly compensated and have adequate medicolegal protection.
Primary Source
American Academy of Dermatology
Armstrong A, et al "Online Care is Equivalent to In-person Care in Managing Psoriasis: A Multi-centered Randomized Controlled Trial" AAD 2018