New Models of Collaborative Care for Atopic Dermatitis

Lawrence F. Eichenfield, MD: I want to mention that we’ve had some experience with a newer collaboration model where we actually do a combination clinic: our multidisciplinary atopic dermatitis program. It’s probably not the most efficient clinic from a doctor’s standpoint because we’re seeing a reduced number of patients, but these are patients with very severe disease. Dr Bob Geng, an allergist, and I see those patients together. We have a physician assistant who was trained in both pediatric dermatology and pediatric allergy. She coordinates the clinic. She spent the first year of her career split to get trained in both specialties. 

The patients are hanging out for 2 hours and getting a lot of didactic education. They’re getting shown where to go to reinforce their education. It’s been tremendously satisfying to see the improvement in the patients and also having that extended time, which continues to teach me about the disease. I don’t expect that’s a model for everywhere, but it’s something that has been really exciting.

Jeffrey M. Bienstock, MD, FAAP: One of the things I want to add is that building that team and selecting the appropriate people that you can work with is very important. In primary care, we see this all the time. I’ll have my associates say to the staff, “Just give them a list.” No, you need to pick off the list who you want because different doctors will mesh different with families. We know that. Having been a pediatrician for almost 35 years, I see that and I know whom I can work with and who will fit better with that family and that patient. 

Then just from a separate aside, there’s the payment issue. Obviously, sometimes some of the subspecialists are not on the same insurance panels that the parents have. That creates even more of a difficulty. They may end up going to somebody I don’t like or trust, and trying to breach that with the family is tough. 

Lawrence F. Eichenfield, MD: Let’s move forward to education. What do we think are good methods to educate patients and their caregivers in terms of up-to-date management? This is increasingly important as we get newer medicines, different kinds of medicines, and newer agents. It’s a rapidly evolving field. I’ll start with Lisa. Do you have any thoughts on what the best way is to educate the patients and families and caregivers, which is different from the health care practitioners? 

Elizabeth A. Swanson, MD: Yes. One of the biggest parts in a busy practice is having the time to really give the proper time and attention for all that discussion and instruction. With my recent move, I was able to redesign my schedule and mandate that new patients with atopic dermatitis are given more time so that I had time to talk to them about what we know about atopic dermatitis.

It’s a rapidly changing world of science and developments, and it’s really exciting. I enjoy talking about it, and it’s nice to have that time to do so. It really helps the families understand the condition better and also understand where we’re coming from as medical providers in our treatment plans, why we’re recommending what we’re recommending, why we think this is great and this is safe, and all that stuff.

Time is the biggest factor because any of us who see atopic dermatitis could talk about it and educate all day. But sometimes we’re short on time.

Lawrence F. Eichenfield, MD: I do think so. I am well aware that the way in which patients collect their information on diseases is changing. It still changes every 6 to 9 months. I’ve been saying that for many years. It’s not just inconsistent. It’s from social media or different websites. For other people, it’s Reddit. There are so many influences.

The good news is we’re getting better tools. There is better stuff if you want handouts. There are better video materials. There’s more out there that can at least help the patients with more significant disease get information as they figure out their methodology for how they want to get educated. We just have to be helpful so they know where that material is available. That’s a key part.

Our outcomes are going to be influenced by patients understanding the disease and then being willing to take on the treatment. We have treatments that go right up to biologic agents. We’re going to have new classes of oral agents as well, along with new topicals that can really drive most patients to being in exceptionally good shape. We’ll have to work through their understanding of that in the new medications.

Transcript Edited for Clarity