Effectiveness of Online vs In-Person Care for Adult Patients With Psoriasis

Investigators examined whether patients benefited from interacting with their dermatologist online rather than in person to manage their psoriasis.

Use of an online, collaborative connected health delivery model has been shown to be as effective as in-person management for the improvement of clinical outcomes among individuals with psoriasis, according to the results of a 12-month, pragmatic, randomized clinical equivalency study (ClinicalTrials.gov identifier: NCT02358135): the Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial. Study findings were published in JAMA Network Open.

The investigators sought to compare an online model for psoriasis with in-person care among adult patients with the disease. Study visits and participant recruitment occurred at multicenter ambulatory clinics between February 2, 2015 and August 18, 2017. The study cohort was composed of adults with psoriasis from Northern California, Southern California, and Colorado. All eligible patients were at least 18 years old, had physician-diagnosed psoriasis, had access to a digital camera or mobile phone with a camera, had internet access, and had a primary care provider.

The participants were randomly assigned in a 1:1 ratio to receive online (n=148) or in-person (n=148) care. Use of the online model allowed both patients and primary care providers to access dermatologists online asynchronously. All dermatologists provided recommendations, assessments, education, and prescriptions online. Patients in the in-person group sought care in person. The frequency of online vs in-person visits was based on medical necessity. The prespecified primary endpoint was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and the in-person groups. Secondary endpoints included body surface area (BSA) affected by psoriasis and Patient Global Assessment score.

A total of 296 patients were randomly assigned to the study, of whom 147 were women and 187 were white. The mean participant age was 49±14 years. The adjusted difference between the online and in-person groups in mean change in PASI. Moreover, the difference in mean change in BSA between the 2 groups was −0.05%; 95% CI, −1.58% to 1.48%.

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With between-group differences in PASI score and BSA within prespecified equivalence margins, equivalence was thus demonstrated between the 2 interventions. The difference in mean change in Patient Global Assessment score between the 2 groups was −0.11; 95% CI, −0.32 to 0.10.

The investigators concluded that the use of innovative telehealth delivery models that emphasize collaboration, efficiency, and quality can play a critical role in the effective management of patients with chronic dermatologic diseases.

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Armstrong AW, Cindy J. Chambers CJ, Maverakis E, et al. Effectiveness of online vs in-person care for adults with psoriasis: a randomized clinical trial. JAMA Netw Open. 2018;1(6):e183062.