The Need for Objective and Remote Tracking of Chronic Skin Diseases
Importance: Managing chronic skin disease is often frustrating for both providers and patients, sometimes resulting in delayed diagnosis, inadequate therapy, and inconsistent care.
Objective: This study performs stakeholder analyses to identify unmet clinical needs in chronic skin disease management.
Methods: Survey of 33 providers and 25 patients at a Stanford Health Care Dermatology department.
Results: When evaluating a chronic skin condition such as psoriasis, 79% of dermatologists rely solely on subjective documentation (gestalt, body surface area, descriptive exam). Objective documentation (photographs or scoring assessment tools) is used by 21% of providers upon initial assessment and by 7% of providers to assess change in disease between office visits. While 83% of providers were comfortable assessing change in disease severity based on prior document by oneself, only 31% were comfortable assessing change based on prior documentation by another provider (p <0.001). Dermatologists expressed the need for better documentation modality in clinic (94%), and in between office visits by patients (91%). While 90% of patients reported it is moderately to extremely important to track their disease, only 16% of patients consistently do. Most patients preferred to monitor their disease at home (92%) using cameras (80%) or by smartphone (59%). Patients were willing to spend 5-30 minutes weekly to monthly to document their disease.
Conclusions and Relevance: This study identifies that dermatologists and patients need a solution that objectively and remotely monitors chronic skin diseases to optimize treatments, empower patients, and provide more cohesive care in a complex healthcare system.
Lim HW, Collins SAB, Resneck JS, et al. The burden of skin disease in the United States. J Am Acad Dermatol. 2017;76(5):958-972.e2. doi:10.1016/j.jaad.2016.12.043
Rappleye E. New-patient wait times for dermatologists in 15 major cities. https://www.beckershospitalreview.com/hospital-physician-relationships/new-patient-wait-times-for-dermatologists-in-15-major-cities.html. Accessed April 15, 2019.
Face S, Dalton S. Consistency of total body surface area assessment in severe burns: Implications for practice. Emerg Med Australas EMA. 2017;29(4):429-432. doi:10.1111/1742-6723.12806
Bożek A, Reich A. The reliability of three psoriasis assessment tools: Psoriasis area and severity index, body surface area and physician global assessment. Adv Clin Exp Med Off Organ Wroclaw Med Univ. 2017;26(5):851-856. doi:10.17219/acem/69804
Spuls PI, Lecluse LLA, Poulsen M-LNF, Bos JD, Stern RS, Nijsten T. How Good Are Clinical Severity and Outcome Measures for Psoriasis?: Quantitative Evaluation in a Systematic Review. J Invest Dermatol. 2010;130(4):933-943. doi:10.1038/jid.2009.391
Gerbens L a. A, Prinsen C a. C, Chalmers JR, et al. Evaluation of the measurement properties of symptom measurement instruments for atopic eczema: a systematic review. Allergy. 2017;72(1):146-163. doi:10.1111/all.12959
Swerlick RA, Zhang C, Patel A, Chren MM, Chen S. The Skindex-mini: a streamlined QOL measurement tool suitable for routine use in clinic. J Am Acad Dermatol. December 2018. doi:10.1016/j.jaad.2018.12.035
Armstrong A, Puig L, Langley R, et al. Validation of psychometric properties and development of response criteria for the psoriasis symptoms and signs diary (PSSD): results from a phase 3 clinical trial. J Dermatol Treat. 2019;30(1):27-34. doi:10.1080/09546634.2017.1364694
mHealth Economics Research Program. www.research2guidance.com. www.research2guidance.com. Published 2016. Accessed April 22, 2019.
Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019 | CMS. https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year. Accessed April 16, 2019.
Abstract - 90 PDF - 11
- There are currently no refbacks.