A new online healthcare model is as effective as in person care for improving functional and psychological outcomes in psoriasis patients, according to a study published in the Journal of the American Academy of Dermatology.
A total of 296 participants were randomly assigned at a ratio of 1:1 to the online care group or in person group. The 12-month study assessed the functional impairment and depression of participants every 3 months from baseline using a 5-level EuroQol-5 Dimensions (EQ-5D-5L) index and Patient Health Questionnaire-9 (PHQ-9). Eligible participants were at least 18 years of age and had active physician-diagnosed plaque psoriasis. The participants were also required to have access to the internet, a digital camera or a phone with a camera, and a primary care physician (PCP).
The online care group participants uploaded clinical images and historical information onto a secure HIPAA-compliant online platform and received recommendations and prescriptions online asynchronously from a dermatologist. These patients were also able to have similar consultations with their PCPs who would, in turn, interact with the dermatologists through the secure online platform; the dermatologists gave recommendations and prescriptions to the patients asynchronously. The in person care group would visit the dermatologists or PCPs in person and receive their care.
EQ-5D-5L consisted of 2 parts: the descriptive system and EuroQol Visual Analogue Scale (EQ VAS). The descriptive system measured mobility, self-care, usual activities, pain and discomfort, and anxiety and depression. EQ VAS allowed participants to self-evaluate the level of overall health. PHQ-9 was used for diagnosing depression and monitoring treatment response.
Investigators found that the between-group difference in the overall improvement in EQ VAS was -0.002, (95% CI, -2.749 to 2.745) which was within the equivalence margin of ±8. The between-group difference in the overall improvement in EQ-5D-5L was 0 (95% CI, -0.003 to 0.003), which was well within the equivalence margin of ±0.1. The between-group difference in the overall improvement in PHQ-9 was -0.33 (95% CI, -1.20 to 0.55), which was also well within the equivalence margin ±3.
One of the important limitations of the study was slightly different attrition rates between online and in person care groups; however, investigators noted that had no impact on results.
The researchers of the study concluded that the online health model was equally effective when compared with in person care for reducing functional impairments and depression in patients with psoriasis.
One author declared associations with the pharmaceutical industry. Please see original reference for a full list of author’s disclosures.
Young PM, Chen AY, Ford AR, Cheng MY, Lane CJ, Armstrong AW. Effects of online care on functional and psychological outcomes in patients with psoriasis: a randomized controlled trial [published online June 5, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.05.089