Children, adolescents with difficult-to-control AD benefit from multidisciplinary approach

Key takeaways:

• The Multidisciplinary Atopic Dermatitis Program was founded to foster team-based management of pediatric patients with AD.
• Results from a study that evaluated this program showed high success and satisfaction.

Children and adolescents with difficult-to-control atopic dermatitis can benefit from a multidisciplinary approach that combines the perspectives of dermatologists, allergists and family members, according to a study.

“A significant challenge in caring for patients with atopic dermatitis is lack of collaboration between health care providers, leading to disjointed care, inconsistent treatment plans and conflicting dialogue with patients,” Alexis Tracy, MD, of the division of allergy and immunology, division of pediatric dermatology, departments of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, and colleagues wrote.

The authors went on to explain that according to a survey distributed by the National Eczema Association, more than half of respondents reported seeing five or more doctors for their own or their child’s AD.

In response to this need for unity in patient care, a collaborative clinic called the Multidisciplinary Atopic Dermatitis Program (MADP) was founded by the Rady Children’s Hospital and UC San Diego Health divisions of dermatology, allergy and immunology and clinical pharmacy.

In this program, experts in dermatology and allergy participated in team-based evaluation and management of children and adolescents with AD by meeting with patients and their families to conduct a comprehensive AD assessment and develop a specific care plan.

Driven by collaboration, the MADP model addressed barriers to shared decision-making by increasing time for patient-provider dialogue, allocating team members to review education modules with patients and families and merging the perspectives from two specialties that usually operate separately.

To evaluate the success of MADP, the researchers conducted a study in which 44 patients (mean age, 7.74 years) with a history of moderate to severe, persistent AD underwent the program, attending one visit at the clinic per month.

Results showed that providers, patients and families observed a significant improvement in AD severity as early as the first follow-up visit.

By the seventh follow-up, patients experienced peak improvement with a 56.04% decrease in body surface area involvement (P < .001) and a 91.52% decrease in EASI scores (P = .008). Patients also saw a mean 2.25-point increase in validated IGA by the seventh visit (P = .009).

Patients experienced the greatest mean improvement in pruritus (4.1; P = .001), Patient Oriented Eczema Measurement scores (11.13; P < .001) and Children’s Dermatology Life Quality Index (12; P < .001) at the sixth visit.

“These results demonstrate that patients with a history of moderate to severe AD can truly benefit from a multidisciplinary approach.”