Improving atopic dermatitis management in a busy primary care setting

Published Online: January 2, 2016

Atopic dermatitis (AD) is often the first step in the “atopic march,” in which infants with AD go on to develop food allergies, asthma and allergic rhinitis. It has been hypothesized that early diagnosis and better treatment of AD at the primary care level may reduce the risk of allergy and asthma, thus reducing patient/caregiver distress and lowering future medical costs. While there is no cure for AD, it can be effectively managed. Education of patients and healthcare professionals is essential to the team-based approach to chronic disease management.

In The Journal of Allergy and Clinical Immunology: In Practice, Meadows et al. outlines a study measuring outcomes before and after a multi-dimensional educational program that provided training, tools and resources to healthcare professionals and patients in primary care clinics. Measures for AD care were selected using clinical recommendations and developed in collaboration with a multi-disciplinary clinic team. Measures were incorporated into a 15-item checklist used in patient visits, focused on assessment of AD severity, incorporation of team-based care, provision of patient education, prescription of medications as appropriate, and follow-up care.

Interventions included hands-on training of all staff at the pediatric clinic network where the study was conducted, as well as multiple in-clinic visits by a National Jewish Health nurse educator and professional education staff. Tools and resources were developed for providers and patients. Electronic tablets at each clinic housed patient information, and were part of resource carts which also included dolls for demonstration, quality of life indexes in English and Spanish, itch severity scales, and educational books. A provider- and patient-targeted website housed educational resources, patient information and interactive games (

Data collected from the checklists completed by 24 prescribing providers in the pediatric clinic network represents the percentage of patient visits in which specific practice elements occurred. The results show immediate improvement on performance measures following the multidisciplinary training and fairly consistent performance for most indicators for the duration of the initiative. Measures were studied either for change in utilization, or for implementation if a particular tool or approach was not existent. Nearly all of the measures that were targeted for increase, regardless of specific patient characteristics, improved to 80% or better. Utilization of tools that assess disease severity and itch severity increased by more than 50%. In self-assessment surveys administered at the conclusion of the initiative, nearly all (93%) of respondents said they made at least some change in behaviors such as assessing AD severity, reviewing the chronic nature of AD with patients, and discussing follow-up plans. Most respondents felt behavior changes outlined in the checklist were sustainable.

This one-year educational, practice improvement initiative increased performance on target measures of quality care for children and adolescents with AD in a primary care clinic network. Performance improvement was possible through continuous engagement with the healthcare team and collaborative quality improvement efforts, including the development of tools for better care of AD patients that have been integrated into the clinical environment.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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