1
|
Zvulunov A, Lenevich S, Migacheva N. A Mobile Health App for Facilitating Disease Management in Children With Atopic Dermatitis: Feasibility and Impact Study. JMIR DERMATOLOGY 2023; 6:e49278. [PMID: 38090787 PMCID: PMC10753416 DOI: 10.2196/49278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/07/2023] [Accepted: 11/22/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Inadequate control of atopic dermatitis (AD) increases the frequency of exacerbations and reduces the quality of life. Mobile health apps provide information and communication technology and may increase treatment adherence and facilitate disease management at home. The mobile health app, Atopic App, designed for patients and their caregivers, and the associated web-based patient education program, Atopic School, provide an opportunity for improving patients' and caregivers' engagement and adherence to the management of AD. OBJECTIVE This noninterventional, observational study aimed to explore the feasibility and potential impact on the management of AD in children by caregivers using the Atopic App mobile health app. METHODS The patient-oriented eczema measure (POEM) and numerical rating scale for the grading of pruritus were used as severity scores (scale range: 0-28). The artificial intelligence model of the app was used to assess the severity of AD based on the eczema area and severity index approach. The deidentified data enabled the analysis of the severity of AD, treatment plan history, potential triggers of flare-ups, usage of available features of the app, and the impact of patient education. RESULTS During a 12-month period, of the 1223 users who installed the app, 910 (74.4%) registered users were caregivers of children with AD. The web-based Atopic School course was accessed by 266 (29.2%) caregivers of children with AD, 134 (50.4%) of whom completed the course. Usage of the app was significantly more frequent among those who completed the Atopic School program than among those who did not access or did not complete the course (P<.001). Users who completed a second POEM 21 to 27 days apart exhibited a significant improvement of AD severity based on the POEM score (P<.001), with an average improvement of 3.86 (SD 6.85) points. The artificial intelligence severity score and itching score were highly correlated with the POEM score (r=0.35 and r=0.52, respectively). CONCLUSIONS The Atopic App provides valuable real-world data on the epidemiology, severity dynamics, treatment patterns, and exacerbation-trigger correlations in patients with AD. The significant reduction in the POEM score among users of the Atopic App indicates a potential impact of this tool on health care engagement by caregivers of children with AD.
Collapse
Affiliation(s)
- Alex Zvulunov
- Sheba Medical Center, Reichman University, Herzliya, Ramat Gan, Israel
| | | | - Natalia Migacheva
- Department of Pediatrics, Samara State Medical University, Samara, Russian Federation
| |
Collapse
|
2
|
Miyashita M, Obara T, Ishikuro M, Kikuya M, Kuriyama S. Association between Recurrence or Exacerbation at Time of Disaster and Allergic Symptoms Several Years Later in Schoolchildren with Asthma or Atopic Dermatitis: The ToMMo Child Health Study. TOHOKU J EXP MED 2022; 257:23-32. [PMID: 35387905 DOI: 10.1620/tjem.2022.j018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University.,Tohoku University Hospital
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University
| | - Masahiro Kikuya
- Tohoku Medical Megabank Organization, Tohoku University.,Teikyo University School of Medicine
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University.,Tohoku University International Research Institute of Disaster Science
| |
Collapse
|
3
|
Sicras-Mainar A, Navarro-Artieda R, Armario-Hita JC. Severe Atopic Dermatitis In Spain: A Real-Life Observational Study. Ther Clin Risk Manag 2019; 15:1393-1401. [PMID: 31819466 PMCID: PMC6897051 DOI: 10.2147/tcrm.s226456] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/03/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To determine the epidemiology and characterize the treatment prescribed for severe atopic dermatitis (AD) in children/adults in usual clinical practice. Methods Observational, retrospective study made through review of medical records of Spanish patients aged ≥6 years. Patients diagnosed with severe AD who required care between 2013 and 2017 were included. The study groups were: 6–12 years; 13–18 years; and > 18 years. Patients were followed for 5 years. The main measurements were the prevalence of AD, comorbidity and treatment duration. Statistical significance was established as p <0.05. Results We included 2323 patients with severe AD. The overall prevalence was 0.10% (95% CI: 0.09–0.11%) and was 0.39%, 0.23% and 0.07% in the 6–12 years, 13–18 years and >18 years age groups, respectively (p <0.001), the percentage of males was 58%, 48.6% and 39%, respectively, and general comorbidity was 0.1, 0.2 and 0.9 points, respectively (p <0.001).The most frequent comorbidities were asthma in 49.0%, 44.9% and 20.8%, respectively (p <0.001), and anxiety in 79.7%, 65.8% and 67.3%, respectively (p <0.001). Oral corticosteroids were administered in 97.3%, 90.9% and 81.7%, respectively (concomitant-medication). Cyclosporine (45.3%), azathioprine (15.9%) and methotrexate (9.0%) were the most frequently prescribed drugs; biologic agents were administered in 5.8% of patients (for AD). Conclusion In AD the presence of comorbidities was significant, especially in the psychological, immunoallergic and cardiovascular areas. Cyclosporine was the most widely used immunosuppressant. There was a degree of variability in the use and duration of the treatments prescribed.
Collapse
Affiliation(s)
| | | | - José C Armario-Hita
- Dermatology Service, Puerto Real University Hospital, Cadiz University, Cádiz, Spain
| |
Collapse
|
4
|
Chernyshov PV. The Evolution of Quality of Life Assessment and Use in Dermatology. Dermatology 2019; 235:167-174. [PMID: 30928986 DOI: 10.1159/000496923] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/15/2019] [Indexed: 11/19/2022] Open
Abstract
The creation of the Dermatology Life Quality Index (DLQI) questionnaire facilitated many studies on the impact of skin diseases on patients' quality of life (QoL). Many national and international guidelines recommend QoL assessment in dermatology, and some of them contain detailed recommendations on treatment goals and changes of treatment approaches based on DLQI score banding and minimal clinically important difference. The methodology of QoL in strument development and validation is constantly becoming more rigorous. Initiatives on selection of core outcome sets for skin diseases are focused on clinical trials but may also be beneficial for clinicians. There are various benefits of using QoL information in clinical practice, but experience of this is very limited at the moment. QoL assessment in dermatology is a rapidly developing field with a gradual shift from theory to practice.
Collapse
Affiliation(s)
- Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine,
| |
Collapse
|
5
|
Alsubeeh NA, Alsharafi AA, Ahamed SS, Alajlan A. Treatment Adherence Among Patients with Five Dermatological Diseases and Four Treatment Types - a Cross-Sectional Study. Patient Prefer Adherence 2019; 13:2029-2038. [PMID: 31819384 PMCID: PMC6899063 DOI: 10.2147/ppa.s230921] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Treatment non-adherence leads to negative therapeutic outcomes and financial burdens on the healthcare system. This study aims to compare the mean adherence scores among patients with five dermatological diseases and four treatment types and to identify the associated patient-related factors. PATIENTS AND METHODS This is a cross-sectional study conducted from January 2019 to August 2019. The questionnaire was distributed among patients attending the outpatient dermatology clinic at King Khalid University Hospital, Riyadh, Saudi Arabia. It included 2330 patients who were over 16 years old and diagnosed with any of the five dermatological diseases (psoriasis, chronic dermatitis, acne vulgaris, hair growth disorders, and vitiligo). The 12-item Medication Adherence Scale was used to quantify the mean adherence score. RESULTS Patients with psoriasis or chronic dermatitis were less adherent to treatments than patients with acne vulgaris, hair growth disorder, or vitiligo. Oral treatment and phototherapy had higher mean adherence scores than injection or topical treatment. High adherence was found in female, single patients; those who did not feel stigmatized from using treatment; those who did not have bad experience with the treatment; those who did not suffer from forgetfulness; those who connected receiving treatment with a habit; those who did not lack treatment responsiveness; those who had an excellent relationship with a dermatologist; and patients with a lesion in an exposed area. Stepwise multiple linear regression was also used to identify the independent variables related to adherence score. CONCLUSION Psoriasis and chronic dermatitis patients had the lowest mean adherence scores. Patient who were on oral medication had the highest adherence score, while those on topical medication had the lowest score. The thoughtful consideration of factors associated with high adherence is important for optimal therapeutic outcomes.
Collapse
Affiliation(s)
| | | | - Shaik Shaffi Ahamed
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Alajlan
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Abdulmajeed Alajlan King Saud University, Riyadh, Saudi ArabiaTel +966 502223030 Email
| |
Collapse
|
6
|
Choi JW, Kim BR, Youn SW. Adherence to Topical Therapies for the Treatment of Psoriasis: Surveys of Physicians and Patients. Ann Dermatol 2017; 29:559-564. [PMID: 28966511 PMCID: PMC5597648 DOI: 10.5021/ad.2017.29.5.559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 12/14/2016] [Indexed: 11/22/2022] Open
Abstract
Background There have been few studies of treatment adherence in Asian patients with psoriasis and understanding of the factors is important to improve outcomes. Objective To provide an overview of treatment adherence among Korean patients with psoriasis and to understand how the perceptions of patients and physicians affect topical treatment adherence. Methods A cross-sectional questionnaire survey was conducted to determine the views and opinions of dermatologists and psoriasis patients on topical treatment adherence. The survey items were developed in collaboration with psoriasis experts. Results Twenty-six dermatologists and fifty patients completed their questionnaire. In the physician survey, more than half of dermatologists only inquired about adherence up to 20% of the time. Most dermatologists generally thought that their patients had high expectations of treatment. Nearly 40% of dermatologists reported that more than 60% of their patients adhered to the prescribed topical treatment. In the patient survey, more than 15% of patients reported that they did not receive enough information about the drug. Around one-fifth of the patients also complained about the physical properties of the products. The majority of patients were confident with the current topical treatments and expected fast improvement, within a couple of weeks. The most common reason for low adherence was forgetfulness. Inconvenience and concerns about side effects were common reasons for topical treatment discontinuation. Conclusion Because adherence to topical treatment is a complex, multifactorial issue with factors varying between patients, dermatologists should focus on determining each patient's individual adherence barriers to achieve good treatment outcomes.
Collapse
Affiliation(s)
- Jee Woong Choi
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo Ri Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Woong Youn
- Department of Dermatology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
7
|
Navarrete-Dechent C, Curi-Tuma M, Nicklas C, Cárdenas C, Pérez-Cotapos ML, Salomone C. Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial. Dermatol Pract Concept 2015; 5:13-6. [PMID: 26693083 PMCID: PMC4667595 DOI: 10.5826/dpc.0504a04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Therapeutic success in acne patients not only depends on the appropriate selection of drugs but also on the patient’s treatment adherence or compliance. Lack of adherence is an important problem both in general medicine and in dermatologic practice. Objective: To evaluate the impact of oral and written counseling on treatment adherence among acne patients. Patients and Methods: Eighty patients were randomized into two groups of 40 patients each. The intervention group received a patient information leaflet (apart from oral counseling), and instructions were reinforced by a telephone call within 15 days of treatment onset. The second group (control group) received treatment indications as usual (oral counseling in-office only). Both groups were followed up with a phone call, evaluating adherence to treatment according to self-reporting of patients at 30, 60, 90 days, and 6 months. Results: Better adherence to treatment was observed in the intervention group. This difference was significant only within the first month of treatment (80% versus 62%, p = 0.043). The beneficial effect of written counseling plus a phone call decreased in subsequent months. Conclusion: Written counseling significantly improves adherence within the first month of treatment. These results suggest that it is reasonable to spend time and resources in written counseling in order to optimize adherence to treatment.
Collapse
Affiliation(s)
- Cristián Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maximiliano Curi-Tuma
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Nicklas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Consuelo Cárdenas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Luisa Pérez-Cotapos
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Salomone
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| |
Collapse
|
8
|
Adherence to Oral and Topical Medications in Cutaneous Lupus Erythematosus is not Well Characterized. Dermatol Ther (Heidelb) 2015; 5:91-105. [PMID: 25899142 PMCID: PMC4470959 DOI: 10.1007/s13555-015-0075-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Treatment adherence plays a large role in chronic dermatologic diseases and may play an important role in the outcomes of patients with cutaneous lupus erythematosus (CLE). We sought to gauge what is currently known about adherence to topical and oral medications in patients with CLE. METHODS A review of MEDLINE was performed using a combination of the phrases "adherence", "compliance", "lupus", and "cutaneous". Studies were hand searched and prospective and cross-sectional studies evaluating medication adherence in patients with CLE and systemic lupus erythematosus (SLE) were included. RESULTS Only two articles explored adherence in patients with CLE, while 17 articles discussed treatment adherence in patients with SLE. Depression was consistently cited as detrimental to adherence. The impact that race, ethnicity, and education has on adherence is unclear. Three studies noted a clear connection between adherence and disease activity, while two others did not. Few studies investigated methods that have improved adherence to treatment which have showed promise. CONCLUSION Much of what we know about adherence to medication in patients with lupus is limited to SLE. Although cutaneous symptoms are among the most common manifestations of SLE, cutaneous disease is often managed at least in part with topical agents, and adherence to topical treatment was not assessed in any of the articles, though one study investigated sunscreen usage in patients with CLE. Understanding adherence in patients with CLE may help contribute to better CLE treatment outcomes.
Collapse
|
9
|
Furue M, Onozuka D, Takeuchi S, Murota H, Sugaya M, Masuda K, Hiragun T, Kaneko S, Saeki H, Shintani Y, Tsunemi Y, Abe S, Kobayashi M, Kitami Y, Tanioka M, Imafuku S, Abe M, Inomata N, Morisky DE, Katoh N. Poor adherence to oral and topical medication in 3096 dermatological patients as assessed by the Morisky Medication Adherence Scale-8. Br J Dermatol 2014; 172:272-5. [PMID: 25154923 PMCID: PMC4303916 DOI: 10.1111/bjd.13377] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M Furue
- Department of Dermatology, Kyushu University, Maidashi 3-1-1, Higashiku, Fukuoka, 812-8582, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|