Objective:

To evaluate the effectiveness of a team-based connected health model compared to conventional in-person care for patients with atopic dermatitis (AD).

Approach:

• Study Design: A pragmatic randomized clinical equivalence trial involving 300 pediatric and adult patients with physician-diagnosed AD from 8 outpatient dermatology clinics in California.
• Intervention: Participants were randomly assigned to receive either asynchronous online care through a connected health platform or conventional in-person care.
• Outcomes: Primary outcome was change in the Eczema Area and Severity Index (EASI) over 12 months; secondary outcomes included changes in the Patient-Oriented Eczema Measure (POEM) and validated Investigator Global Assessment (vIGA).

Key Findings:

• The connected health model met criteria for equivalence on the primary outcome, with improvements in EASI comparable to in-person care.
• Improvements in patient-reported symptoms (POEM) and physician-assessed disease severity (vIGA) also met equivalence criteria.
• Safety outcomes were comparable between groups, with serious adverse events being uncommon and unrelated to interventions.
• Patients in the connected health model had substantially lower use of in-person specialty care.

Interpretation:

Limitations:

• Baseline disease severity was relatively low, limiting generalizability to more severe AD cases.
• Participation required internet access and digital literacy, potentially limiting applicability in certain populations.
• Part of the study was conducted during the COVID-19 pandemic, which may have influenced telemedicine use.

Conclusion:

Sources:

• JAMA Dermatology